Information needs of women during early treatment for breast cancer

This study assessed the information needs of 70 women with breast cancer being treated by surgery, chemotherapy or radiation therapy. Information needs were measured by the breast cancer version of the Toronto Informational Needs Questionnaire (TINQ-BC). All women had high information needs, irrespective of type of treatment received. They mainly wanted information about their disease, treatments and investigative tests. An examination of individual items on the TINQ-BC revealed that all women wanted information about recurrence, specifically they wanted to know if the cancer would come back and how to tell if it had recurred. The results provide nurses with some direction as to what information to give women receiving early treatment for breast cancer.     

Evaluating the self-assessed support needs of women with breast cancer

Evaluating the self‐assessed support needs of women with breast cancer Aims of the study. The first aim of the study was to identify the self‐assessed support needs of women with breast cancer at various points of illness and, secondly, to establish if these needs formed clusters which could provide the basis for developing a standardized scale of needs for use by breast care teams in the evaluation of care. Background. It has been found that support given to women with breast cancer has a positive effect upon their reactions to the illness and may even prolong their survival. Given that breast cancer affects a large number of women it is obviously important that those affected receive, in addition to the best available medical treatment, the type of support that best meets their needs. This study aimed to provide information on the impact of breast cancer and the need for various types of support by examining women’s own assessment of their needs at different stages of their illness. Design and methods. A purposive sample of 12 women with a diagnosis of breast cancer was selected in one health authority in England, United Kingdom (UK). Women selected represented a wide age range (between 26 and 58), were married or in long‐term cohabiting relationships and were at different points on the illness trajectory. Women were invited to take part in a semi‐structured interview about their experiences of breast cancer. The data from these interviews were analysed using the software package Qualitative Solutions and Research, Nonnumerical Data Indexing, Searching and Theorizing (QSR*NUDIST). Following this content analysis, a questionnaire was formulated which divided statements into seven categories: diagnosis, treatment, support, femininity and body image, family and friends, information and after care, to be rated on a Likert scale ranging from ‘of no importance’ to ‘extremely important’. Questionnaire data were analysed by means of a one‐way analysis of variance (for three independent variables) or t‐test for two independent variables. Results. The questionnaire was sent to 971 women and achieved a response rate of 50·4%. The mean score for statements of need reached the level of point 4 on the Likert scale (important) with three exceptions: having professional help with family problems and domestic upheaval, coping with feelings of anger and dealing with the question ‘why me?’ Conclusion. With the above three exceptions, women experienced a high level of need associated with a diagnosis of breast cancer. Studies of this kind should enable resources to be targeted to areas of highest need.     

Healthcare and support needs of women with suspected breast cancer

AIM: This paper is a report of a study to investigate changes in the healthcare and support needs during the diagnostic period, and factors that affect these needs in women with suspected breast cancer. BACKGROUND: Although the needs of women with breast cancer are well recognized, few studies have examined the needs of women with suspected breast cancer during the diagnostic period. METHOD: This longitudinal study used an investigator-developed, self-administered questionnaire to collect data from 127 women in Taiwan on three occasions: notification of need for breast biopsy, before biopsy and after diagnosis. The data were collected from November 2004 to April 2005. FINDINGS: Participants had high need levels before and after diagnosis, with their top needs in the domains of healthcare services for diagnosis, follow-up and consultation, and information about the disease. They needed disease- and treatment-related information more than emotional support. Need levels were higher (P < 0.01) before diagnosis than after, highest before biopsy, and lowest after diagnosis. Furthermore, needs were higher (P < 0.01) before than after diagnosis for diagnostic services, disease information, and involvement of family and friends. Higher needs were found in married women with more education and no history of benign tumours. Need level did not differ statistically significantly by age, religious status, degree of social support, family history and breast symptoms. CONCLUSION: Need levels of women with suspected breast cancer vary during the diagnostic period, are highest before breast biopsy, and related to personal characteristics and cultural context. Therefore, during this period, nursing staff should provide patients and families with culturally sensitive, individualized, supportive care.     

The psychometric properties of the Miller Behavioural Style Scale with adult daughters of women with early breast cancer: a literature review and empirical study

Several researchers have suggested that the information-seeking behaviours of patients need to be taken into consideration when assessing their information needs. This study reviews published evidence of the psychometric properties of the Miller Behavioural Style Scale, a tool commonly used to identify the information-seeking behaviours of individuals under threat, and examines its reliability and validity with adult daughters of women with early breast cancer. Ninety-seven adult daughters completed the MBSS and a 30-item, self-administered questionnaire, a tool designed to explore the information needs of adult daughters of women with breast cancer. The internal consistency of the monitoring and blunting sub-scales of the MBSS was alpha = 0.65 and 0.41 respectively. The blunting sub-scale fell substantially below acceptable limits and was discarded from subsequent analyses. The monitoring sub-scale possessed good test-retest reliability (n = 17) with a 5-week time interval (r= 0.71, P < 0.005), as measured using a Pearson's correlation coefficient. Furthermore, the majority (73.4%) of monitoring items possessed moderate or substantial test-retest reliability, as indicated by kappa coefficients. Finally, the monitoring sub-scale possessed good construct validity, both discriminant and convergent validity, as measured by the univariate associations between monitoring behaviour and selected items from the information questionnaire and a demographic questionnaire. In conclusion, adequate support exists for the psychometric properties of the monitoring sub-scale of the MBSS and its use with adult daughters of women with early breast cancer in future research. These findings have a number of implications for nursing research and these are discussed in this paper.     

Meeting the information needs of women with breast cancer: Piloting a nurse-led intervention

This study evaluated a telephone intervention, administered by specialist breast care nurses, that aimed to meet the information needs of women with breast cancer. The intervention was developed from previous work that examined priority information needs. Participants were allocated to a telephone intervention (n = 67) or control group (n = 68). Data were collected by means of semi-structured interviews with participants at two time points (3 months and 8-12 months post-diagnosis) and focused on patient satisfaction with sources of information, information needs and psychological morbidity. Interviews were also conducted with breast care nurses to ascertain their views on administering the intervention. The intervention group reported fewer physical problems at Time 2 and were more likely to have had their information needs met than women in the control group. The control group were more likely to utilise media sources of information at Time 2 whereas women in the intervention group reported breast care nurses as their most prominent source of information. There were no significant differences in psychological morbidity between the two study groups. The findings indicate that the intervention is a feasible and acceptable approach to meeting the information needs of women with breast cancer. Further research is required to evaluate the intervention in a randomised controlled trial.     

Information needs and decision-making preferences: Comparing findings for gynaecological, breast and colorectal cancer

This study examined information needs and decision-making preferences for women with gynaecological cancers (n=53) using structured interviews and compared findings to previous work involving breast and colorectal cancer patients. Measures of information needs (Information Needs Questionnaire) and decision-making preferences (Control Preferences Scale) were administered to women with gynaecological cancers, consistent with measures previously administered to breast (n=150) and colorectal (n=42) cancer patients. Therefore, statistical comparisons could be made across study groups. Priority information needs were similar across the three cancer groups and related to information about likelihood of cure, spread of disease and treatment options. Patients across study groups preferred to share or delegate decision-making to doctors, rather than make decisions themselves. However, patients with gynaecological and colorectal cancers were more likely to have achieved their preferred role in decision-making than women with breast cancer. There were clear similarities in priority information needs across cancer patients groups. However, decision-making preferences need to be established on an individual basis to ensure that patients are involved in the decision-making process to the extent that they prefer. The research instruments used in this study have potential as clinical guides to enable health professionals to make an individual assessment of needs and preferences.     

Psychometric properties of the Chinese Breast Cancer Screening Beliefs questionnaire

BackgroundBreast cancer is the most common type of cancer in women. The Chinese Breast Cancer Screening Beliefs (CBCSB) questionnaire was developed to measure Chinese–Australian women’s beliefs, knowledge and attitudes about breast cancer and breast cancer screening.PurposeTo assess the psychometrics of the modified version CBCSB in a Chinese-speaking community.MethodsTwo items in the original CBCSB were removed because they were not applicable to the Hong Kong setting, which resulted in an 11-item CBCSB. A total of 730 women aged at least 18 years old without a history of breast cancer self-completed the questionnaire.ResultsBased on 730 Chinese-speaking women with mean age of 43 years, the three hypothesized subscales of the CBCSB had Cronbach’s alpha ranging between 0.69 and 0.75. Non-responses to the items were at most only 3.3%. The corrected item-total correlations for the hypothesized subscales ranged from 0.35 to 0.63 and were higher than those for the competing subscales. As hypothesized, the frequency of health practices was significantly associated with all subscales of the CBCSB. Confirmatory factor analysis showed an adequate fit for the hypothesized three-factor structure of the modified CBCSB questionnaire.ConclusionsThe 11-item CBCSB questionnaire was culturally appropriate, reliable and valid in a Chinese-speaking community setting. It can be used to gain understanding of Chinese-speaking women’s beliefs, knowledge and attitudes about breast cancer and breast cancer screening. It may also serve as an outcome for the development and assessment of public education programs for breast cancer screening.     

Lymphoedema care of breast cancer patients in a breast care clinic: a survey of knowledge and health practice

Lymphoedema, an accumulation of protein-rich fluid in interstitial tissue, is a well-recognised life-altering result of breast cancer treatment. With the goal of studying the prevalence and management of lymphoedema after breast cancer therapy, 171 patients were invited to complete a self-administered questionnaire following completion of treatment for breast cancer. The survey revealed that 82.5% of patients knew they were at-risk of developing lymphoedema. However, the level of knowledge about preventive care in lymphoedema was inadequate, with a mean score of 4.07 out of a full mark of 10 (SD=2.35, mode=2). A substantial proportion (45.6%; n=78) of respondents reported that they had experienced lymphoedema and subsequently developed multiple sites of lymphoedema, but only 34.7% (n=26) had been referred for physiotherapy. The study also revealed that patients who had received the combined regimen of mastectomy, lymph node dissection, radiotherapy and chemotherapy were at a higher risk of developing lymphoedema (chi2=6.305, P=0.043). Interestingly, it was found that nurses were the most frequently cited resource for information, but the least consulted professionals for discussion on treatment. It is apparent from our patient survey that there is a lack of knowledge on lymphoedema care amongst breast cancer patients. In order to improve patients' level of knowledge and their awareness of lymphoedema care, the provision for systematic and comprehensive patient education, including management protocols for lymphoedema, needs to be addressed. Education and training, will be essential components of efforts to ensure appropriate care for lymphoedema patients.     

Informational and psychosocial needs of women choosing conservative surgery/primary radiation for early stage breast cancer

Recent advances in the treatment of early stage breast cancer give women a choice of treatments. Prospective and retrospective studies demonstrate the comparable efficacy of treatment with a modified radical mastectomy and treatment with conservative surgery and primary radiation. While the number of women with early stage breast cancer choosing the latter treatment continues to increase, there is a paucity of information in the nursing literature assessing the informational and psychosocial needs of this group. This article reports the results of a questionnaire assessing the informational and psychosocial needs of patients choosing breast conservation surgery, and the future implications of these results for the nursing profession.     

My Wife Has Breast Cancer: The Lived Experience of Arab Men

ObjectivesBreast cancer is a leading cause of mortality and morbidity among women in Middle Eastern countries. In Bahrain, breast cancer is the second-leading cause of death and first among women. Prior research has shown that Middle Eastern women will often delay seeking treatment for breast cancer and subsequently hide the diagnosis from friends and family. As a result, women rely heavily on their spouses for support and care. There is limited research on spouses’ experience of breast cancer, especially in the Middle East. This study explored the lived experience of Arab men following their wives’ diagnosis and treatment for breast cancer in Bahrain.Data SourcesData from semi-structured interviews with Arab men (n = 6) were analyzed using the interpretative phenomenological approach (IPA). Participants’ wives had completed their treatment 3 to 6 months prior to the interviews.ConclusionThree main themes emerged: Perceptions of breast cancer diagnosis and treatment, coping strategies, and impact on quality of life. Findings revealed that Arab men in Bahrain relied on family and friends for support and drew on religious beliefs to give them hope so they could better support their wives. Findings also highlighted the unique culturally related coping strategies used by Arab men. This study highlights the specific needs of Arab men following their wives’ diagnosis and treatment for breast cancer. Faith and beliefs were overwhelmingly a foundation for coping and support. Therefore, this must be considered within the health care service to improve support strategies for Arab patients and their spouses in treatment and care plans encompassing a holistic interprofessional, multidisciplinary, and communicative approaches including the need for culturally sensitive care pathways that are cognizant of the care needs through help-seeking and information-sharing throughout the illness. Nurses should provide the education and encourage open communication among the couple and their family.Implications for Nursing PracticeFindings can be used by nurses and other health care professionals to provide better support and holistic care to Arab women with breast cancer and their spouses.     

Factors influencing women in seeking help from a health care professional on self discovery of a breast symptom,in an Irish context

Aim. To identify the extent of delay and the factors influencing women in seeking help from a health care professional on self discovery of a breast symptom, in an Irish context. Background. Breast cancer is the most common malignancy among women in the developed world. In Ireland, 2700 women are diagnosed with breast cancer and over 900 die from it annually. A longer delay in presenting with breast symptoms is associated with a lower rate of survival from breast cancer. However, many women wait for longer than three months before presenting to a health care professional on self discovery of a breast symptom. Design. A quantitative correlational design was used. Methods. Data were collected using the ‘Women’s help seeking for breast symptoms’ questionnaire. Women were recruited in the breast clinic prior to their visit with the consultant. Results. A total of 100 women participated, 99 of whom fully completed the questionnaire. Mean age was 40 years. It was found that 72·7% (n = 73) of women visited their GP within one month, 14·1% (n = 14) within one to three months and 10% (n = 12) after three months. Delay time was significantly related to women’s knowledge and beliefs and social issues. Conversely, help seeking also correlated to women’s knowledge and beliefs about the symptom and the anxiety surrounding the initial symptom discovery period. Conclusion. Despite breast health promotion campaigns, many women delay for one month or more, in seeking help from a health care professional for self discovered breast symptoms. Prolonged delay has potential to impact on survival from breast cancer. This highlights the need for continued education and breast health promotion for women. Relevance to clinical practice. Health care professionals need to be aware of possible reasons for delay in seeking help for self discovered breast symptoms and explore new ways to address these barriers.     

110例乳腺癌女性患者健康素养与癌症复发恐惧的相关性研究

目的 调查乳腺癌女性患者健康素养及癌症复发恐惧现状,并探究两者的相关性。方法 采用一般资料调查表、中文版疾病进展恐惧简化量表、慢性病患者健康素养量表对江西省某三级甲等医院110例乳腺癌女性患者进行调查,采用Pearson相关性分析检验其健康素养及癌症复发恐惧的相关性。结果 乳腺癌患者健康素养总分为（88.32±10.41）分,复发恐惧得分为（28.98±6.11）分,患者健康素养水平与癌症复发恐惧呈负相关（r=-0.773,P<0.01）。结论 乳腺癌患者健康素养处于中等水平,癌症复发恐惧处于中等偏低水平,健康素养与癌症复发恐惧呈负相关,即健康素养水平越低,其癌症恐惧程度越高。建议医护人员提供针对性的信息支持、鼓励患者与外界沟通互动、开展心理社会干预等以提升乳腺癌女性患者健康素养水平,继而减轻其对癌症复发的恐惧。     

Major concerns and needs of breast cancer patients

Between 1989 and 1991, 102 breast cancer patients completed a questionnaire survey on concerns and needs at their first visit to the University Clinic after they were diagnosed or treated for breast cancer at other clinics. Their major concerns and needs were health, family, finances, work, the future, self-esteem, counseling and support for themselves and their family. Married women and those younger than 50 years were more likely to have concerns about their family. Nonwhites had more concerns about finances and work than white women, with an odds ratio (OR) of 6.58. Older women and those married, however, had less concerns about finances and work than younger women and those not married, with ORs of 0.96 and 0.34, respectively. Fewer nonwhite than white patients expressed concerns about their future (OR = 0.31). Young women were more concerned about self-esteem than older women. More nonwhites than whites and more married than unmarried women expressed needs for family counseling and support (OR = 3.58 and 3.68, respectively). Help for interpreting information was required more frequently by nonwhites than whites (OR = 7.25, 95% confidence interval [CI] = 2.19-24.00). Nonwhite women also tended to require more referrals than whites. In summary, major concerns and needs varied among patients of different demographic characteristics, especially those of age, race, and marital status.     

Quality of life in women with breast cancer: a review of the literature and implications for nursing practice

This article discusses the gap between an ever-increasing interest in research on the quality of life in patients with breast cancer and the lack of impact this research has had in the actual care of these women. A critical review of the literature is used to answer the question of how much can be accepted as established knowledge despite the often methodologically weak studies and contradictory results. Deficiency in research studies is no rationale for not improving nursing care in areas wherein there is an expressed need for support and assistance. Nurses are in contact with patients who have breast cancer at all stages of the disease and treatment, because they meet the women in the hospital, at the outpatient clinic, and in their homes. They play an important role in meeting the needs of these women. Ways of improving nursing practice at the different stages of the illness, from the pretreatment phase to posttreatment follow-up assessment, are discussed, and concrete suggestions made. This article addresses the women's need both for adequate information and for social and emotional support.     

Self-transformation as a factor in the self-esteem and well-being of breast cancer survivors

Diagnosis with a life-threatening illness can lead to many changes in one's self. These changes, called self-transformation, are not well understood. The present study used triangulation of methods and measures to (i) describe individual differences in self-transformation among breast cancer survivors, (ii) examine factors associated with self-transformation in breast cancer survivors, and (iii) examine the relationships between self-transformation and self-esteem and well-being in breast cancer survivors and age-matched comparison women without cancer. Cancer survivors (n = 60) participated in structured interviews and both survivors and comparison women (n = 60) completed a set of questionnaires. Narrative analysis revealed three categories of transformation among breast cancer survivors: positive transformation, minimal transformation and feeling stuck. These groups differed by age, marital status and income, but not by disease or treatment variables. Breast cancer survivors in the positive transformation group had significantly higher self-esteem and well-being in comparison with (i) survivors grouped as feeling stuck and (ii) age-matched counterparts without cancer. Cancer survivors who reported feeling stuck had significantly lower self-esteem and well-being than the other groups of survivors and lower well-being in comparison with healthy women of the same age. Findings provide support for the concept of self-transformation and a new understanding of disease, demographic and treatment factors associated with the concept. Findings also suggest that self-transformation may be a factor in the self-esteem and well-being of breast cancer survivors.     

Information needs of adolescents when a mother is diagnosed with breast cancer.

This pilot study was undertaken to increase our understanding of the information needs of adolescents when a mother is diagnosed with breast cancer. In-depth interviews with 13 adolescents provided insight into the types of questions they had at the time of their mother's diagnosis and how satisfied they were with the access they had to information. These adolescents had many questions about cancer and its treatment, specific questions about their mother's disease and survival, and concerns about their own risk. Each sought information on their own in addition to conversations with one or both parents. They identified their most pressing concern as the need to know about their mother's survival. All felt it was important to have access to information and to have someone with whom they could talk about what was happening. This person needed to be someone with whom they were comfortable and whom, in turn, had both credibility and comfort with emotions. Clearly, adolescents experience needs for information when their mother is diagnosed with breast cancer. Cancer nurses can assist women diagnosed with breast cancer plan how to support their adolescent children and meet the needs for information.     

What are the information needs of Chinese breast cancer patients receiving chemotherapy?

Cancer patients demand information, not only to assist them to understand the disease and its treatment, but also to allow them to interpret the aversive events and action taken, so that the threat inherent from the diagnosis becomes lessened. With the goal of studying the information needs of women with breast cancer who were receiving chemotherapy, 51 patients were invited to complete a self-administered questionnaire at the beginning and again at half way through their chemotherapy treatment. The results showed that for these patients the cancer and its spread, the side effects of chemotherapy and the management of the side effects were the priority information needs in the early stages and following chemotherapy. Among 52 questions, only six items were revealed to have significant difference when compared with the Time 1 and Time 2 measures. The results reflect that over time information needs for this group of patients was relatively stable. Marital status and subscale of disease was found significant difference at the first and second time points. The findings indicate that there is a need for the provision of a family-centered education program that addresses patient's information needs, cultural sensitivity, the use of building up and ongoing.     

Effect of supportive care on the anxiety of women with suspected breast cancer

Title.  Effect of supportive care on the anxiety of women with suspected breast cancer.
Aim.  This paper is a report of a study of the effect of supportive care on anxiety levels of women with suspected breast cancer during the diagnostic period.
Background.  Informational and psychosocial support has been shown to improve care outcomes for women with breast cancer. However, little is known about the effect of supportive care on women's psychological status during the breast cancer diagnostic period.
Methods.  For this longitudinal quasi-experimental study, 122 participants were recruited from a large teaching hospital in Taiwan. The experimental group ( n  =   62) received a supportive care programme that included health education pamphlets about breast cancer diagnosis and treatment, three face-to-face sessions of informational and emotional support, and two follow-up telephone consultations. The control group ( n  =   60) received routine care. Data were collected from October 2006 to April 2007 using the State-Trait Anxiety Inventory at baseline (notification of need for breast biopsy), before biopsy, and after receiving biopsy result (diagnosis).
Findings.  After adjusting for covariance of breast discomfort, regular breast self-examination, and biopsy result, the anxiety levels of women receiving supportive care were significantly lower before biopsy ( P  =   0·017) and after diagnosis ( P  =   0·001) than those of women receiving routine care.
Conclusion.  Supportive care that incorporates informational and emotional support and follow-up telephone consultations can decrease anxiety levels of women with suspected breast cancer. These findings can serve as a reference for clinical nursing staff to improve care quality during the breast cancer diagnostic period by providing women with individualized and culturally sensitive care.     

Treatment adherence of youth and young adults with and without a chronic illness

The present study was undertaken to explore the psychosocial functioning of young people with chronic illness, their beliefs about treatment adherence, difficulties with adherence and concerns about living with their illness. A small correlational study was undertaken to compare the psychosocial functioning of young people, with and without chronic illness, aged between 12 and 24 years. Subjects were recruited from a metropolitan teaching hospital. Group 1 included 44 young people with chronic illness; Group 2 included 41 young people without chronic illness. Both groups were divided on the basis of age: younger (12-18 years, n = 24); older (19-24 years, n = 61) and sex (female = 43; male = 42). Subjects completed the Achenbach self-report questionnaire as a measure of psychosocial functioning, and a second questionnaire constructed for this study to explore treatment adherence. Psychosocial functioning scores were found to be similar on the majority of subscales. Young women with chronic illness were, however, found to have significantly higher internalizing scores than young women without chronic illness. A significant negative relationship was found for the chronic illness group between internalizing scores and treatment adherence. The findings highlight potential areas of difficulty in psychosocial functioning of some young people with chronic illness. They also suggest the existence of a subgroup of young people with chronic illness who experience more problems than their peers. More research is needed to generate evidence about this possible subgroup to determine predictors of psychosocial functioning and test the timing and efficacy of psychosocial interventions.