The patient experience of radiotherapy for breast cancer: A qualitative investigation as part of the SuPPORT 4 All study

IntroductionBreast cancer is a global health problem with 2.09 million cases of breast cancer diagnosed worldwide in 2018. With an increase in breast cancer survival attention has now focussed on the impact treatment side effects can have on the quality of life for women during survivorship. The aim of the SuPPORT 4 All project is to develop a support bra for use during radiotherapy, that can reduce normal tissue toxicity (for women with larger breasts) and provide accuracy, dignity and modesty for all women. The first stage of the project involved a co-design process to understand the current patient experience where no support bra or modesty device is used.MethodA participatory co-design methodology was adopted. Workshops were held with patient representatives (n = 9) to seek understanding of experience during radiotherapy; a total of three workshops over 4 h. The workshops were audio recorded and framework analysis was adopted to identify key patient experiences.ResultsTwelve categories and twenty-six sub categories were identified specific to patient experience. Patient concerns focussed on information provision, Healthcare Practitioner (HCP) knowledge of breast lymphoedema, lack of choice, experiences of being naked, and feelings of disempowerment.ConclusionsA number of areas were identified that had negative effects on overall patient experience.Implications for practicePractitioners should consider patient dignity when configuring services to support patient needs regarding undressing, outside or inside the linear accelerator room. Additionally, practitioners should have an understanding of the impact permanent tattoos may have on some patients’ wellbeing and the impact that breast lymphoedema has on patient quality of life. Practitioners should also consider methods to encourage patient empowerment during radiotherapy; supporting patient self-monitoring of side-effects may be one way to facilitate this.     

Dynamic association between parental monitoring and communication and adolescent risk involvement among African-American adolescents

PURPOSE: To examine: (1) the relationship between parental monitoring and communication and adolescent risk involvement over time, including consideration of their potential interaction; and (2) the effect of consistent versus inconsistent monitoring and communication over time on adolescent risk behaviors. METHODS: Baseline and follow-up data were collected from 1999-2003. A total of 817 African-American adolescents and their parents were recruited from 35 low-income urban communities in Baltimore, MD. Perceived parental monitoring, parent-adolescent communication and seven risk behaviors were assessed. Logistic general estimating equation (GEE) models were performed to assess the dynamic association. RESULTS: Perceived parental monitoring had protective effects on concurrent adolescent risk involvement over two-year observation. The protective effect on girls' sexual abstinence increased significantly over time. Perceived problem communication was associated with increased risk of concurrent involvement in violent behaviors, but the effect did not change over time. For girls, the probability of engaging in sex increased greatly (from 0.3 to 0.6) for those who perceived problem communication, while it remained stable (about 0.4) for those perceiving less problem communication. CONCLUSIONS: The data confirm the protective effect of perceived parental monitoring on adolescent risk involvement. It also extends previous findings by showing the importance of consistent parental monitoring and communication.     

Synapses, circuits, and the ontogeny of learning

This article summarizes the proceedings of a symposium organized by Mark Stanton and Pamela Hunt and presented at the annual meeting of the International Society for Developmental Psychobiology. The purpose of the symposium was to review recent advances in neurobiological and developmental studies of fear and eyeblink conditioning with the hope of discovering how neural circuitry might inform the ontogenetic analyses of learning and memory, and vice versa. The presentations were: (1) Multiple Brain Regions Contribute to the Acquisition of Pavlovian Fear by Michael S. Fanselow; (2) Expression of Learned Fear: Appropriate to Age of Training or Age of Testing by Rick Richardson; (3) Trying to Understand the Cerebellum Well Enough to Build One by Michael D. Mauk; and (4) The Ontogeny of Eyeblink Conditioning: Neural Mechanisms by John H. Freeman. Taken together, these presentations converge on the conclusions that (1) seemingly simple forms of associative learning are governed by multiple "engrams" and by temporally dynamic interactions among these engrams and other circuit elements and (2) developmental changes in these interactions determine when and how learning emerges during ontogeny.     

Project Kealahou: Improving Hawai‘i's System of Care for At-Risk Girls and Young Women through Gender-Responsive,Trauma-Informed Care

Project Kealahou (PK) is a six-year, federally-funded program aimed at improving services and outcomes for Hawai‘i''s female youth who are at risk for running away, truancy, abuse, suicide, arrest and incarceration. PK builds upon two decades of sustained cross-agency efforts among the state''s mental health, juvenile justice, education, and child welfare systems to promote system-of-care (SOC) principles of community-based, individualized, culturally and linguistically competent, family driven, youth-guided, and evidence-based services. In addition, PK emphasizes trauma-informed and gender-responsive care in serving its target population of females ages 11–18 years who have experienced psychological trauma.Results from the first four years of the implementation of PK in the Department of Health''s (DOH) Child and Adolescent Mental Health Division (CAMHD) highlight the serious familial, socioeconomic, functional, and interpersonal challenges faced by the young women who receive services in Hawai‘i''s SOC. Despite the challenges faced by PK youth and their families, preliminary results of the evaluation of PK show significant improvements across multiple clinical and functional domains of service recipients. A financial analysis indicates that these outcomes were obtained with a minimal overall increase in costs when compared to standard care alone. Overall, these results suggest that PK may offer a cost effective way to improve access, care, and outcomes for at-risk youth and their families in Hawai‘i.