Development of a supportive care framework for breast cancer survivor's unmet needs: A modified Delphi study.

AIM: To establish a supportive care framework for addressing unmet needs among breast cancer survivors, providing practical guidance for healthcare providers to assess and manage these needs, ultimately enhancing the health outcomes and quality of life of breast cancer survivors. DESIGN: We conducted a two-round Delphi survey to gather expert opinions regarding the unmet needs supportive care framework for breast cancer survivors. METHODS: Initial framework identification and inquiry questionnaire creation was achieved via literature search and expert group discussions, which included 15 experts from nursing practice, clinical medicine, nursing management and nursing education was conducted using a Delphi survey. To establish consensus, a two-round Delphi poll was done, using criteria based on the mean (≥4.0), coefficient of variation (CV < 0.25) and percentage for entire score (≥20%). RESULTS: Experts reached a consensus, leading to six care modules, and 28 care entries: Tumour Detection Support (three care entries), Management of Complications of Antitumor Therapy (seven care entries), Healthy Lifestyle Management (five care entries), Sexual and Fertility Support (four care entries), Psychosocial Support (four care entries) and Resource and Linkage Support (five care entries). CONCLUSION: To address breast cancer survivors' unmet needs, a supportive framework was developed to actively enhance their health outcomes. However, further refinement and feasibility testing using mobile devices or artificial intelligence are required. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: This pioneering framework prioritises addressing unmet needs and equips healthcare providers to assess and manage these needs effectively, facilitating the implementation of programs aimed at improving the well-being of breast cancer survivors. REPORTING METHOD: This study was guided by a modified guideline for the Conducting and Reporting of Delphi Studies (CREDES) (Palliative Medicine, 31(8), 684, 2017). PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution. TRIAL AND PROTOCOL REGISTRATION: The Delphi study methodology does not require registration.

Status quo of advanced cancer patients participating in shared decision-making in China: a mixed study.

PURPOSE: Patients with advanced cancer are usually willing to participate in shared decision-making (SDM), but in clinical practice, patient participation is easily ignored. This study aimed to analyze the current SDM status of advanced cancer patients and related factors. METHODS: In quantitative research, we administered a cross-sectional survey to 513 advanced cancer patients in 16 tertiary hospitals in China. A sociodemographic information questionnaire, the Control Preference Scale (CPS), and Perceived-Involvement in Care Scale (PICS) were used to analyze current SDM status and influencing factors. Our qualitative research was based on the Ottawa Decision Support Framework (ODSF), and 17 advanced cancer patients were interviewed to explore their perceptions of SDM. RESULTS: Our quantitative results show that patients' actual and expected decision-making participation differed; statistically significant influencing factors were age, insurance, and whether patients were worried about the therapeutic effects. We also found that dynamic decision-making mode changes, disease information acquisition, decision-making participation obstacles, and family members' roles affected patients' SDM through qualitative interviews. CONCLUSION: Advanced cancer patients' SDM in China is dominated by sharing and continuously fluctuates. Influenced by Chinese traditional culture, family members play an important role in SDM. In clinical work, we should pay attention to the dynamic changes in patients' participation in decision-making and the role of family members.

Breast Cancer Stigma Scale: A Reliable and Valid Stigma Measure for Patients With Breast Cancer.

Purpose: This study aims to develop and validate a stigma scale for Chinese patients with breast cancer. Methods: Patients admitted to the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, for breast cancer treatment participated in this study. Development of the Breast Cancer Stigma Scale involved the following procedures: literature review, interview, and applying a theoretical model to generate items; the Breast Cancer Stigma Scale's content validity was assessed by a Delphi study (n = 15) and feedback from patients with breast cancer (n = 10); exploratory factor analysis (n = 200) was used to assess the construct validity; convergent validity was assessed with the Social Impact Scale (n = 50); internal consistency Cronbach's α (n = 200), split-half reliability (n = 200), and test-retest reliability (N = 50) were used to identify the reliability of the scale. Results: The final version of the Breast Cancer Stigma Scale consisted of 15 items and showed positive correlations with the Social Impact Scale (ρ = 0.641, P < 0.001). Exploratory factor analysis (EFA) revealed four components of the Breast Cancer Stigma Scale: self-image impairment, social isolation, discrimination, and internalized stigma, which were strongly related to our perceived breast cancer stigma model and accounted for 69.443% of the total variance. Cronbach's α for the total scale was 0.86, and each subscale was 0.75-0.882. The test-retest reliability with intra-class correlation coefficients of the total scale was 0.947 (P < 0.001), and split-half reliability with intra-class correlation coefficients of the total scale was 0.911 (P < 0.001). The content validity index (CVI) was 0.73-1.0. Conclusion: The newly developed Breast Cancer Stigma Scale offers a valid and reliable instrument for assessing the perceived stigma of patients with breast cancer in clinical and research settings. It may be helpful for stigma prevention in China.

Unmet needs of 1210 Chinese breast cancer survivors and associated factors: a multicentre cross-sectional study.

BACKGROUND: Breast cancer survivors (BCSs) often have potential unmet needs. Identification of the specific needs of BCSs is very significant for medical service provision. This study aimed to (1) investigate the unmet needs and quality of life (QoL) of BCSs in China, (2) explore the diverse factors associated with their unmet needs, and (3) assess the association between their unmet needs and QoL. METHODS: A multicentre, cross-sectional survey was administered to 1210 Chinese BCSs. The Cancer Survivor Profile-Breast Cancer and the Functional Assessment of Cancer Therapy-Breast scale were administered to survivors who gave informed consent to participate. Data were analysed using t-test, ANOVA, multiple regression analysis, and Pearson correlations. RESULTS: The 1192 participants completed questionnaires (response rate 98.51%). Our study reveals that the most prevalent unmet needs were in the 'symptom burden domain'. The unmet needs of BCSs depend on eleven factors; age, time since diagnosis, education level, occupation, payment, family income status, stage of cancer, treatment, family history of cancer, pain, and physical activities. To ensure the provision of high-quality survivorship care and a high satisfaction level, more attention should be paid to actively identifying and addressing the unmet needs of BCSs. The problem areas identified in the Cancer Survivor Profile for breast cancer were negatively associated with all subscales of QoL except the health behaviour domain, with the correlation coefficient ranging from - 0.815 to - 0.011. CONCLUSION: Chinese BCSs exhibit a high demand for unmet needs in this study, and the most prevalent unmet needs were in the 'symptom burden domain'. There was a significant association between patients' unmet needs (as defined in the Cancer Survivor Profile for breast cancer) and QoL. Future research should focus on enhancements to survivorship or follow-up care to address unmet needs and further improve QoL.