Challenges of illness in metastatic breast cancer: a low-income African American perspective.

OBJECTIVE: Disparities in breast cancer survival and treatment for African American and low income women are well documented, yet poorly understood. As care for women with metastatic breast cancer (MBC) evolves to a chronic care model, any inequities in optimal treatment and management of symptoms must also be identified and eliminated. The purpose of this study was to explore how race and income status influence women's experiences with MBC, particularly the management of symptoms, by describing the perceived challenges and barriers to achieving optimal symptom management among women with MBC and exploring whether the perceived challenges and barriers differed according to race or income. METHOD: Quantitative techniques were used to assess demographics, clinical characteristics, symptom distress, and quality of life and to classify women into groups according to race and income. Qualitative techniques were used to explore the perceived challenges, barriers, and potential influences of race and income on management of symptoms in a prospective sample of 48 women with MBC. RESULTS: Commonalities of themes across all groups were faith, hope, and progressive loss. Low-income African American women uniquely experienced greater physical and social distress and more uncertainty about treatment and treatment goals than the other delineated racial and economic groups. SIGNIFICANCE OF RESULTS: There are many commonalities to the challenges of illness presented to women with MBC. There are also interesting, emerging thematic racial and economic differences, most compelling among the low income African American women with resultant practice and research implications.

Applying projective techniques to formative research in health communication development.

This article describes a new approach to formative research in which projective techniques commonly used in psychological assessment were adapted for use in focus groups to help design colorectal-cancer screening materials for African American men and women. Participants (N = 20) were divided into six "design teams." Each team was given a selection of design supplies and asked to create and discuss a visual layout for screening materials. Participants chose design elements that reflected visual preferences that they felt would connect meaningfully with other African Americans. The dynamics within the design teams were different than in traditional focus groups, with participants having more control over the group's direction. Using projective techniques helped draw out unique information from participants by allowing them to "project" their opinions onto objects. This approach may be a valuable tool for health-promotion and health-communication practitioners seeking insight on the implicit values of a priority population.

Development of a spiritually based breast cancer educational booklet for African American women.

Breast cancer is a significant health problem among African American women. Since the church is a viable health education venue for this population, spiritual cancer communication is a timely area of study to promote cancer education. In partnership with an African American church, we developed an educational booklet on breast cancer early detection from within a spiritual framework. Working with an advisory panel of women from the church, we facilitated the development of the booklet content and design. Panel members selected the spiritual themes and scripture used to frame the early detection messages, and they wrote messages to be included in the booklet. Meetings with focus groups were conducted to generate feedback on the booklet design and content. Overall feedback from the advisory panel and three focus groups regarding this level 4 spiritually based cancer communication intervention for African American women was generally consistent, showing strong preferences for design and content. We believe that this spiritually based approach may be one way to make cancer communication more culturally appropriate for African American women.