What causes breast cancer? A systematic review of causal attributions among breast cancer survivors and how these compare to expert-endorsed risk factors

Purpose

The aim of this paper was to review published research that analyzed causal attributions for breast cancer among women previously diagnosed with breast cancer. These attributions were compared with risk factors identified by published scientific evidence in order to determine the level of agreement between cancer survivors’ attributions and expert opinion.

Methods

A comprehensive search for articles, published between 1982 and 2012, reporting studies on causal attributions for breast cancer among patients and survivors was undertaken. Of 5,135 potentially relevant articles, 22 studies met the inclusion criteria. Two additional articles were sourced from reference lists of included studies.

Results

Results indicated a consistent belief among survivors that their own breast cancer could be attributed to family history, environmental factors, stress, fate, or chance. Lifestyle factors were less frequently identified, despite expert health information highlighting the importance of these factors in controlling and modifying cancer risk. This review demonstrated that misperceptions about the contribution of modifiable lifestyle factors to the risk of breast cancer have remained largely unchanged over the past 30 years.

Conclusions

The findings of this review indicate that beliefs about the causes of breast cancer among affected women are not always consistent with the judgement of experts. Breast cancer survivors did not regularly identify causal factors supported by expert consensus such as age, physical inactivity, breast density, alcohol consumption, and reproductive history. Further research examining psychological predictors of attributions and the impact of cancer prevention messages on adjustment and well-being of cancer survivors is warranted.     

Risk work in NHS 111: the everyday work of managing risk in telephone assessment using a computer decision support system

The substitution of clinical with non-clinical staff to triage and manage calls in the NHS urgent care services is one of the number of measures designed to meet growing health services demand. The deployment of a Computer Decision Support System ‘NHS Pathways’ to support this work has created a new type of health worker and a new form of risk work. In this article, we examine how call handlers manage, experience and respond to risk in their everyday practice of telephone assessment. We draw on data from an ethnographic study of 5 NHS 111 sites involving 356 h of observation plus 6 focus groups with 47 health services staff in 2011–2012. We found that there was a ‘risk problem’ involving balancing the competing demands of assessing patients safely against rationing limited health resources. The new service used technology to support risk management but this technology also created risk work for call handlers, clinicians and patients. We found that call handlers engaged in risk work that involved interpretation, judgement and flexibility in using NHS Pathways. Call handlers also deferred some risk work to both clinicians and patients/callers. Risk work now involves ‘making the technology work’ and much of this work has been delegated to non-clinical call handlers. These new healthcare workers are interpreters of risk. Risk work creates a sense of responsibility (and sometimes anxiety) for these non-clinical call handlers.     

Doing Foucault: inquiring into nursing knowledge with Foucauldian discourse analysis

Foucauldian discourse analysis (FDA) is a methodology that is well suited to inquiring into nursing knowledge and its organization. It is a critical analytic approach derived from Foucault's histories of science, madness, medicine, incarceration and sexuality, all of which serve to exteriorize or make visible the ‘positive unconscious of knowledge’ penetrating bodies and minds. Foucauldian discourse analysis (FDA) holds the potential to reveal who we are today as nurses and as a profession of nursing by facilitating our ability to identify and trace the effects of the discourses that determine the conditions of possibility for nursing practice that are continuously shaping and (re)shaping the knowledge of nursing and the profession of nursing as we know it. In making visible the chain of knowledge that orders the spaces nurses occupy, no less than their subjectivities, FDA is a powerful methodology for inquiring into nursing knowledge based on its provocation of deep critical reflection on the normalizing power of discourse.     

Wheat flour sensitisation and airways disease in urban bakers.

A total of 176 bakers and 24 subjects employed as bread slicers and wrappers were studied to examine the effect of occupational category on respiratory symptoms, ventilatory capacity, non-specific bronchial reactivity, and prick skin test responses to wheat and common allergens. Bakers had a greater prevalence of attacks of wheeze and dyspnoea and more frequently considered that work affected their chests than did slicers and wrappers. Bakers with a history of asthma with onset since starting work in a bakery had a greater prevalence of chronic cough and sputum, increased bronchial reactivity, and positive prick skin test responses to wheat and common allergens than other bakers. There was a significant association between the frequency of positive prick skin tests to wheat and common allergens, suggesting that prior atopy facilitates sensitisation to cereal antigens. The frequency of positive prick skin responses to common allergens, however, declined with increasing baking duration whereas the frequency of positive skin responses to wheat increased with increasing baking duration, suggesting that subjects who were sensitised to common allergens were leaving the industry whereas subjects who stayed in the industry increased their risk of developing sensitisation to wheat. Oven handlers had a greater prevalence of attacks of wheeze and dyspnoea and more frequently considered that work affected their chests than either dough makers or general bakers. They also had a greater prevalence of positive prick skin test responses to wheat than dough makers or general bakers. Oven handlers also had a lower mean standardised casual FEV1 than either general bakers or dough makers. Thus oven handlers appear to have a greater risk of developing respiratory allergy and airflow obstruction than bakers in other occupational categories.     

Nurses’ preparedness for infectious disease outbreaks: A literature review and narrative synthesis of qualitative evidence

Aims and objectives

To explore the core components that constitute nurses’ preparedness in an epidemic event.

Background

Healthcare service providers have worked to augment efforts to protect the public from the impact of epidemic events. While constituting the major healthcare taskforce, nurses are frequently tasked with fronting the response to an infectious disease outbreak. Given the crucial role of nurses in the management of prevailing epidemics, the constituents of their preparedness in epidemic events should be identified.

Design

A systematic search was undertaken to identify eligible studies from the literature. A narrative synthesis approach was employed to extract and synthesise findings of the reviewed qualitative studies.

Methods

Seven qualitative studies on nurses’ experience and perceptions of epidemic events were examined for scientific quality using the Critical Appraisal Skills Programme Qualitative Checklist. Findings of these studies were synthesised adopting a narrative synthesis approach.

Results

Three interplaying themes were identified as follows: (i) personal resources, (ii) workplace resources and (iii) situational influences. The findings suggest that an effective epidemic outbreak response would require further effort to reinforce the interplay between individual nurses, healthcare institutions and the governments.

Conclusions

The practical interplay among individual nurses, healthcare institutions and the governments is crucial in establishing an effective epidemic response. Further research on the understanding of the dynamic process of preparedness development is recommended to set future directions in research.

Relevance to clinical practice

This study offers important insights for devising future strategies in enhancing nurses’ preparedness and response to an epidemic event. These include recommendations on providing education and training to nurses regarding infectious diseases, fostering institutional assistance and support in an outbreak and revising government policies and planning.     

Social Justice: A Concept Analysis

Social justice is presented frequently as a core or shared value at the very foundation of nursing practice. Despite its acceptance as a core value, its use is varied and there has been inherent difficulty in establishing a definitive explanation for what is meant by social justice. As such, a clearly defined meaning for the concept of social justice does not exist in contemporary nursing literature. Following the method outlined by Walker and Avant, an analysis of the concept of social justice provides clarity to the meaning of social justice as it is used within the nursing profession, in academia, education, and practice.