The Role of Stress in Breast Cancer Incidence: Risk Factors, Interventions, and Directions for the Future.

Stress is a common belief among breast cancer patients and the public to explain variation in breast cancer incidence. Epidemiological studies interrogating the relationship between stress and cancer have reported mixed results. The impact of the topic and the lack of consensus has sparked this review of the literature to investigate gaps in knowledge and identify areas of research. We first present a brief summary of the biopsychosocial model generally used to conduct research on stress. We then divide the overview of the literature into areas of research focus. These include the role of distressing life events in breast cancer incidence, the role of adverse childhood events in later breast cancer incidence, the importance of race and socioeconomic status (SES) as social determinants of breast cancer incidence, and the specific role of chronic stress in relation to breast cancer. For each topic, we discuss the potential of stress as a risk factor and possible intervention strategies that could reduce the effects of stress. We then identify further research questions to be probed to fill the gaps in knowledge. We conclude with a discussion of future research directions for stress research as it relates to breast cancer incidence.

Transformacion Para Salud: a patient navigation model for chronic disease self-management.

Increased cost of chronic illnesses in United States is an urgent call to develop a cost effective approach to improve chronic disease self-management, especially among vulnerable populations. An emerging role for professionals and paraprofessionals is the patient navigator. We present an example of a conceptual framework, Transformation for Health, developed to underpin the training of certified community health workers (CHW) to deliver health care, preventive services, and health education for underserved populations to promote chronic disease self-management. Transformacion Para Salud (TPS), a patient navigation model for chronic disease self-management, was a two year demonstration program to develop a culturally sensitive intervention to facilitate patient behavior changes. Patients involved in the TPS intervention showed improvements in clinical and behavioral outcomes after twelve months of intervention. This article describes the conceptual basis and implementation of the TPS and discusses program evaluation, specific intervention outcomes, and implications for practice. Use of CHWs in the patient navigator role demonstrated a cost effective method to improve access to quality, cost-effective, primary health care services as well as to facilitate chronic disease self-management.

Clinical ladders: the next generation.

Existing clinical ladders established in 2005 at Seton Family of Hospitals were updated and put into place in 2008. They were based on established nursing ladders. Original ladders were first established to keep technologists motivated by giving them more responsibilities and opportunities to grow. Ladders also gave the higher performing technologists more compensation for doing more work. Seton Imaging modified the technologist ladder to include non-technical responsibilities as well as some nonhospital activities to enable technologists who consistently go above and beyond their job duties to be promoted up the ladder. The ladder has 62 pathway options for points, so it allows for tailoring to staff interest or site restrictions.