Predictors of quality of life among ethnically diverse breast cancer survivors.

PURPOSE: Few studies have examined predictors of quality of life (QOL) of breast cancer survivors over time. METHODS: Breast cancer survivors (n=116) were asked to complete measures of QOL, mood, spirituality, and social support every 6 months from 2-4 years post treatment. RESULTS: Overall QOL at 4 years was predicted by previous physical and functional well-being, the breast cancer-specific items, and vigor and current levels of social support (Adj R2=.72, F=30.53, p<.001). Physical QOL was predicted by previous levels of physical and functional well- being and current levels of functional and social/family well-being (Adj R2=.84, F=44.30, p<.001). Functional well- being was predicted by prior levels of physical, functional, and social/family well-being and current levels of physical well-being and vigor (Adj R2=.72, F=3-.53, p<.001). Emotional well-being was predicted by previous levels of emotional well-being and current physical well-being, the breast cancer-specific items, and anxiety (Adj R2=.60, F=26.30, p<.001). Social/family well-being was predicted by previous levels of social/family well-being, social support, and confusion (Adj R2=.71, F=34.18, p<<000). The breast cancer-specific items were predicted by age, previous levels of the breast cancer-specific items, confusion and current levels of emotional and functional well-being and spirituality (Adj R2=.58, F=17.57, p<.001). CONCLUSIONS: Over all and specific dimensions of QOL at 4 years were predicted by different combinations of QOL, mood, and spirituality. Interventions should be tailored to which dimensions of QOL are affected and other types of QOL as well as social support, mood, and spirituality as coping mechanisms that influence the specific dimension of QOL affected.

Older women, breast cancer, and social support.

INTRODUCTION: One in ten women over the age of 65 will develop breast cancer. Despite this high incidence of breast cancer among older women, social support for them is often inadequate. This paper describes a qualitative study of the impact of a breast cancer diagnosis on older women from racially/ethnically diverse populations and their subsequent need for social support. METHODS: Forty-seven older African American, Asian American, Caucasian and Latina women between the ages of 65 to 83 participated in a larger study examining the impact of breast cancer on women from racially/ethnically diverse populations and the meaning and nature of social support. The women completed an in-depth qualitative interview on the psychosocial impact of breast cancer and the meaning and nature of social support. RESULTS AND CONCLUSION: The results indicate that there are variations in reactions to a breast cancer diagnosis among older women, and that these reactions impact their experiences with seeking social support at diagnosis and during treatment. Respondents were concerned about their aging bodies, potential dependency on others, and loss of autonomy. At the same time, the severity of cancer treatment and existing co-morbidities often meant they needed to learn to receive support, and to reach out if they had no support. The implications of these findings underscore the older cancer patient's need to strengthen her supportive networks at the time of diagnosis, during treatment, and post-treatment.

Emotion work: disclosing cancer.

INTRODUCTION: Breast cancer remains one of the leading causes of morbidity and mortality for all women in the US. Current research has focused on the psychological relationship and not the sociological relationship between emotions and the experience of breast cancer survivors. This paper focuses on the emotion work involved in self-disclosing a breast cancer diagnosis in a racially or ethnically diverse population. METHODS: The participants (n = 176) selected for this study were African American, Asian American, Latina, and Caucasian women who had been diagnosed with stages 0, I, or II breast cancer within the past 4 years. They completed an in-depth qualitative interview on self-disclosure and social support. FINDINGS: The results indicate self-disclosing was done at a time when important decisions about treatment needed to be made. Different strategies for disclosure were used, all of which entailed emotion work. Respondents talked about the various elements of emotion work in the disclosure process including: managing others' worry, protecting and soothing others, and educating and instructing others. For many respondents, disclosure without calculating emotional management meant opening up to others which meant support and an increase in emotional resources. CONCLUSIONS: The findings in this paper have implications for women with breast cancer and demonstrate the need for women to be involved in honest disclosure and less emotional management of others' feelings. There is also a need for education about the nature of the cancer experience among people who are not well educated about the treatment and consequences of cancer. This need may be even stronger among racial and ethnic minorities.

The benefits of prayer on mood and well-being of breast cancer survivors.

OBJECTIVES: Prayer is becoming more widely acknowledged as a way to cope with cancer. The goal of this study was to compare differences in use of prayer between breast cancer survivors from different ethnic groups and examine how use of prayer is related to mood and quality of life. METHODS: This study used a mixed methods design. One hundred and seventy-five breast cancer survivors participated in a longitudinal study of survivorship. Women completed in-depth qualitative interviews and a battery of measures including quality of life, spirituality, social support, and mood. RESULTS: Eighty-one percent of the women prayed. There were no significant differences between the groups for any of the psychological, social support, or quality of life variables with the exception of higher benefit finding and spiritual well-being among those who prayed. The data did show that women who prayed were able to find more positive contributions from their cancer experience than women who did not pray. The interviews showed that those who prayed tended to be African American or Asian, Catholic or Protestant. The prayers were for petitioning, comfort, or praise. Some of the women stated that they had difficulty praying for themselves. CONCLUSIONS: While there seems to be few differences in terms of standardized measures of quality of life, social support, and mood between those who prayed and those who did not, the interviews showed that certain ethnic minority groups seem to find more comfort in prayer, felt closer to God, and felt more compassion and forgiveness than Caucasian women.

Training community resource center and clinic personnel to prompt patients in listing questions for doctors: follow-up interviews about barriers and facilitators to the implementation of consultation planning.

BACKGROUND: Visit preparation interventions help patients prepare to meet with a medical provider. Systematic reviews have found some positive effects, but there are no reports describing implementation experiences. Consultation Planning (CP) is a visit preparation technique in which a trained coach or facilitator elicits and documents patient questions for an upcoming medical appointment. We integrated CP into a university breast cancer clinic beginning in 1998. Representatives of other organizations expressed interest in CP, so we invited them to training workshops in 2000, 2001, and 2002. OBJECTIVES: In order to learn from experience and generate hypotheses, we asked: 1) How many trainees implemented CP? 2) What facilitated implementation? 3) How have trainees, patients, physicians, and administrative leaders of implementing organizations reacted to CP? 4) What were the barriers to implementation? METHODS: We attempted to contact 32 trainees and scheduled follow-up, semi-structured, audio-recorded telephone interviews with 18. We analyzed quantitative data by tabulating frequencies and qualitative data by coding transcripts and identifying themes. RESULTS: Trainees came from two different types of organizations, clinics (which provide medical care) versus resource centers (which provide patient support services but not medical care). We found that: 1) Fourteen of 21 respondents, from five of eight resource centers, implemented CP. Four of the five implementing resource centers were rural. 2) Implementers identified the championing of CP by an internal staff member as a critical success factor. 3) Implementers reported that modified CP has been productive. 4) Four respondents, from two resource centers and two clinics, did not implement CP, reporting resource limitations or conflicting priorities as the critical barriers. CONCLUSION: CP training workshops have been associated with subsequent CP implementations at resource centers but not clinics. We hypothesize that CP workshops combined with an internal champion and adequate program resources may be sufficient for some patient support organizations to implement CP.

Ethnicity and spirituality in breast cancer survivors.

INTRODUCTION: Many women are incorporating spirituality as a way of coping with cancer. However, few studies have examined the role of spirituality in mood and quality of life among breast cancer survivors from different ethnic groups. METHODS: One hundred and seventy-five women who had completed treatment for breast cancer participated in in-depth interviews about their experiences. Transcripts were available for 161 women. RESULTS: The majority (83%) of the women talked about their spirituality. The main themes were: (1) God as a Comforting Presence; (2) Questioning Faith; (3) Anger at God; (4) Spiritual Transformation of Self and Attitude Towards Others/Recognition of Own Mortality; (5) Deepening of Faith; (6) Acceptance; and (7) Prayer by Self. A higher percentage of African-Americans, Latinas, and Christians felt comforted by God than the other groups. CONCLUSIONS: These results are consistent with the common assumption that more African-American and Latinas engage in spiritual activities and that African-Americans are more fatalistic than the other groups. IMPLICATIONS FOR CANCER SURVIVORS: The present findings suggest that there are several dimensions of spirituality experienced among cancer survivors. For many the trauma of a cancer diagnosis might deepen their faith and appreciation of life as well as changing the way they view at themselves, their lives, and how they relate to those around them, including God.

Improving the quality of decision making in breast cancer: consultation planning template and consultation recording template.

PURPOSE/OBJECTIVES: To describe two templates that can be used to improve the quality of breast cancer treatment decisions. DATA SOURCES: Case study, survey of current users, three clinical trials. FINDINGS: Clinical applications of the Consultation Planning Template and Consultation Recording Template vary across organizations. Clinical trials have demonstrated that the templates can improve the quality of decisions, the quality of communication between patients and providers, and satisfaction. CONCLUSIONS: The templates can be adapted to different clinical settings and can improve the quality of treatment decisions. IMPLICATIONS FOR NURSING: Nurses often provide the majority of education and coaching for patients making decisions. As patients' demands for involvement in decision making increase, nurses need practical tools to help patients participate. The templates are practical tools that nurses can use to help patients make better decisions.