Interpreting differences in patterns of supportive care needs between patients with breast cancer and patients with colorectal cancer.

BACKGROUND: Understanding cancer patients' supportive care needs can help optimize health-care systems and inform services development. We therefore examined the prevalence of supportive care needs in Chinese breast (BC) and colorectal cancer (CRC) patients to identify prevalence and correlates of unmet needs. METHODS: We assessed supportive care needs (Supportive Care Needs Survey-Short Form), psychological distress (the Hospital Anxiety and Depression Scale), symptom distress (The Memorial Symptom Assessment Scale-Short Form), and satisfaction with care (Patient Satisfaction Questionnaire) among 210 Chinese BC (97) or CRC (104) outpatient clinic attendees. RESULTS: Breast cancer patients (89.7%) reported more unmet needs (χ(2) = 4.409, p = 0.027), but both CRC and BC samples ranked unmet needs prevalence similarly, with health system and information needs reported as the most common. Younger patients reported higher health system and information and sexuality needs. After multivariate adjustment, the strength of unmet needs did not differ by cancer type. Unmet psychological, physical and daily living, and sexuality needs were positively associated with greater symptom distress. Greater health system information needs were associated with high global distress and low depression scores, whereas greater psychological needs were associated with higher anxiety scores. CONCLUSIONS: Hong Kong Chinese BC and CRC patients strongly prioritized needs related to health systems and information provision. Symptoms and psychological distress were associated with unmet needs, reflecting a service shortfall in symptom management. Improving care provision by optimizing communication and clinic organization can better prepare cancer patients for their rehabilitation and improve symptom control.

Unmet supportive care needs: a cross-cultural comparison between Hong Kong Chinese and German Caucasian women with breast cancer.

The comparison of psychosocial needs across different cultural settings can identify cultural and service impacts on psychosocial outcomes. We compare psychosocial needs in Hong Kong Chinese and German Caucasian women with breast cancer. Completed questionnaires were collected from 348 Chinese and 292 German women with breast cancer for assessing unmet psychosocial needs (Supportive Care Needs Survey Short Form), psychological distress (the Hospital Anxiety and Depression scale), and listed physical and psychological symptoms. Only 11% of the participants reported not needing help for any of the 34 items. More German (14%) than Chinese women (8%) reported no unmet needs (χ(2) = 6.16, P = .013). With both samples combined, the Health System and Information domain unmet needs were the most prevalent, apart from one Psychological need domain item, "Fear about the cancer spreading." Chinese and German samples differed significantly in prevalence and patterns of unmet psychosocial needs. Multivariate adjustment for demographic, clinical, and sample characteristics, psychological distress, and symptoms showed that significantly greater unmet Health system and Information, and Patient care and support domain needs, associated with the presence of symptoms (ß = .232, P < .001), high HADS Anxiety (ß = .187, P < .001), higher education attainment (ß = .120, P = .002), and Chinese sample membership (ß = .280, P < .001). Greater unmet Psychological, Physical and Daily Living, and Sexuality domain needs were associated with the presence of symptoms, psychological distress, and German group membership, among others. German women reported more anxiety (t = 10.45, P < .001) and depression (t = 3.71, P < .001). In post hoc analyses, German, but not Chinese women reporting greater anxiety and depression had greater unmet Psychological and Sexuality domain needs (P < .001). It can be concluded that culture-specific differences in supportive care needs exist. Hong Kong Chinese women prioritize needs for information about their disease and treatment, whereas German Caucasian women prioritize physical and psychological support. Planning for cancer supportive care services or interventions to reduce unmet needs must consider cultural and/or health service contexts.

Development and pilot-testing of a Decision Aid for use among Chinese women facing breast cancer surgery.

BACKGROUND: Women choosing breast cancer surgery encounter treatment decision-making (TDM) difficulties, which can cause psychological distress. Decision Aids (DAs) may facilitate TDM, but there are no DAs designed for Chinese populations. We developed a DA for Chinese women newly diagnosed with breast cancer, for use during the initial surgical consultation. AIMS: Conduct a pilot study to assess the DA acceptability and utility among Chinese women diagnosed with breast cancer. METHODS: Women preferred the DA in booklet format. A booklet was developed and revised and evaluated in two consecutive pilot studies (P1 and P2). On concluding their initial diagnostic consultation, 95 and 38 Chinese women newly diagnosed with breast cancer received the draft and revised draft DA booklet, respectively. Four-day post-consultation, women had questionnaires read out to them and to which they responded assessing attitudes towards the DA and their understanding of treatment options. RESULTS: The original DA was read/partially read by 66/22% (n = 84) of women, whilst the revised version was read/partially read by 74/16% (n = 35), including subliterate women (χ(2) = 0.76, P = 0.679). Knowledge scores varied with the extent the booklet was read (P1: F = 12.68, d.f. 2, P < 0.001; P2: F = 3.744, d.f. 2, P = 0.034). The revised, shorter version was graphically rich and resulted in improved perceived utility, [except for the 'treatment options' (χ(2) = 5.50, P = 0.019) and 'TDM guidance' (χ(2) = 8.19, P = 0.004) sections] without increasing anxiety (F = 0.689, P = 0.408; F = 3.45, P = 0.073). CONCLUSION: The DA was perceived as acceptable and useful for most women. The DA effectiveness is currently being evaluated using a randomized controlled trial.