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1.
Eur Eat Disord Rev ; 26(2): 92-111, 2018 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-29282801

RESUMEN

OBJECTIVE: To systematically review the literature reporting outcomes of augmentative family-based treatment (FBT) interventions for adolescents with restrictive eating disorders (EDs). METHOD: Articles were identified through a systematic search of five electronic databases (PsycINFO, MEDLINE, EMBASE, CINAHL, Cochrane Database). RESULTS: Thirty articles were included, reporting on FBT augmentations featuring adjunctive treatment components, modified treatment structure and/or content with adherence to FBT principles, and adaptations allowing FBT delivery in different settings. All reported significant improvements in weight and/or ED symptoms at end-of-treatment, although few compared augmentative and standard FBT interventions and good quality follow-up data was generally lacking. CONCLUSIONS: There is early evidence for the effectiveness of augmentative FBT-based approaches in facilitating weight and/or ED symptom improvements for adolescents with restrictive EDs. There remains a lack of robust evidence demonstrating superior effects of such approaches over standard FBT, and further controlled studies are required to expand on the current evidence. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.


Asunto(s)
Anorexia Nerviosa/terapia , Peso Corporal/fisiología , Terapia Familiar/métodos , Trastornos de Alimentación y de la Ingestión de Alimentos/terapia , Adolescente , Anorexia Nerviosa/psicología , Humanos , Resultado del Tratamiento
2.
Breast ; 31: 233-240, 2017 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-27969575

RESUMEN

OBJECTIVES: Contralateral prophylactic mastectomy (CPM) reduces the risk of contralateral breast cancer (BC) following unilateral BC, but may not increase survival in BRCA1/2 mutation negative women. Despite this, and the risk for adverse physical and psychological impact, uptake is increasing in BRCA1/2 mutation negative women. We aimed to quantify the degree of reduction in lifetime contralateral BC risk women required to justify CPM, and to explore demographic, disease and psychosocial predictors of preferences using Protection Motivation Theory (PMT) as a theoretical framework. Reasoning behind preferences was also examined. MATERIALS AND METHODS: 388 women previously diagnosed with unilateral BC, of negative or unknown BRCA1/2 status, were recruited from an advocacy group research database. Two hypothetical risk trade-off scenarios were used to quantify the reduction in lifetime contralateral BC risk that women judged necessary to justify CPM, using a 5% and 20% baseline. Demographic, disease and PMT measures were assessed using a questionnaire. RESULTS: Most women required their risk to be more than halved from a 5% or 20% baseline to justify CPM. Polarised preferences were also common, with some women consistently accepting or refusing CPM independent of risk/benefit trade-offs. Preferences were associated with coping self-efficacy and having a prior CPM. Explanations for judging CPM worthwhile included reducing or eliminating contralateral BC risk, attaining breast symmetry and reducing worry. CONCLUSION: Risk-reduction preferences were highly variable. Decisive factors in women's preferences for CPM related to clinical, psychological and cosmetic outcomes, but not to demographic or disease characteristics.


Asunto(s)
Neoplasias de la Mama/prevención & control , Neoplasias de la Mama/psicología , Prioridad del Paciente , Mastectomía Profiláctica/psicología , Adolescente , Adulto , Anciano , Ansiedad/etiología , Ansiedad/prevención & control , Neoplasias de la Mama/cirugía , Toma de Decisiones , Femenino , Genes BRCA1 , Genes BRCA2 , Humanos , Persona de Mediana Edad , Mutación , Teoría Psicológica , Medición de Riesgo , Autoeficacia , Encuestas y Cuestionarios , Adulto Joven
3.
Patient Educ Couns ; 99(5): 814-22, 2016 May.
Artículo en Inglés | MEDLINE | ID: mdl-27529090

RESUMEN

OBJECTIVE: Most women diagnosed with unilateral breast cancer without BRCA1 or BRCA2 mutations are at low risk of contralateral breast cancer. Contralateral Prophylactic Mastectomy (CPM) decreases the relative risk of contralateral breast cancer, but may not increase life expectancy; yet international uptake is increasing. This study applied protection motivation theory (PMT) to determine factors associated with women's intentions to undergo CPM. METHODS: Three hundred eighty-eight women previously diagnosed with unilateral breast cancer and of negative or unknown BRCA1 or BRCA2 status were recruited from an advocacy group's research database. Participants completed measures of PMT constructs based on a common hypothetical CPM decision-making scenario. RESULTS: PMT constructs explained 16% of variance in intentions to undergo CPM. Response efficacy (CPM's advantages) and response costs (CPM's disadvantages) were unique individual predictors of intentions. CONCLUSION: Decision-making appears driven by considerations of the psychological, cosmetic and emotional advantages and disadvantages of CPM. Overestimations of threat to life from contralateral breast cancer and survival benefit from CPM also appear influential factors. PRACTICE IMPLICATIONS: Patients require balanced and medically accurate information regarding the pros and cons of CPM, survival rates, and recurrence risks to ensure realistic and informed decision-making.


Asunto(s)
Toma de Decisiones , Motivación , Prioridad del Paciente , Mastectomía Profiláctica/psicología , Neoplasias de Mama Unilaterales/diagnóstico , Neoplasias de Mama Unilaterales/cirugía , Adulto , Australia , Estudios Transversales , Femenino , Humanos , Intención , Esperanza de Vida , Persona de Mediana Edad , Teoría Psicológica , Medición de Riesgo , Autoeficacia , Encuestas y Cuestionarios , Neoplasias de Mama Unilaterales/psicología
4.
Eur J Oncol Nurs ; 21: 57-65, 2016 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-26952679

RESUMEN

PURPOSE: Most women with unilateral breast cancer (BC) without BRCA1/2 gene mutations are at low risk of contralateral breast cancer (CBC). One CBC risk-management option is contralateral prophylactic mastectomy (CPM). While there is no evidence that CPM increases life-expectancy, its uptake is increasing. This study aimed to assess the validity of an extended social-cognition model, the Theory of Planned Behaviour (TPB), in predicting women's intentions to undergo CPM. METHOD: Four hundred women previously treated for BC completed an online survey exploring demographic and disease factors, attitude, subjective norm, perceived behavioural control, anticipated regret, uncertainty avoidance, self-efficacy to not have CPM and intentions to undergo CPM in a common hypothetical decision-making scenario. RESULTS: The TPB uniquely explained 25.7% of intention variance. Greater anticipated regret, uncertainty avoidance and lower self-efficacy to cope with not having CPM were associated with stronger CPM intentions, explaining an additional 7.7%, 10.6% and 2.9% respectively, of variance over and above the TPB. Women who had undergone CPM, had not attended university, and had children reported stronger CPM intentions. CONCLUSIONS: A holistic understanding of CPM decision-making appears to require consideration beyond CBC risk, demographics and disease characteristics, exploring women's expectations about CPM outcomes, others' opinions, and avoidance of emotionality and difficulties associated with not undergoing surgery. This study provides a theoretical basis from which the complexity of CPM decision-making may be understood, and from which resources for patients and treating staff may be developed to support women's informed decision-making aligning with their personal values.


Asunto(s)
Neoplasias de la Mama/prevención & control , Toma de Decisiones , Intención , Mastectomía Profiláctica , Adulto , Neoplasias de la Mama/psicología , Estudios Transversales , Emociones , Femenino , Humanos , Persona de Mediana Edad , Autoeficacia , Factores Socioeconómicos
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