Time-Related Characteristics of Medical and Psychosocial Decisions in Japanese Women with Breast Cancer: Results of a Web-Based Open-Ended Response.

BACKGROUND: This study aimed to articulate chronological characteristics of decisions made by Japanese women with breast cancer (BC) since their diagnosis. METHODS: Open-ended questions were asked using an Internet-based cross-sectional survey method. Qualitative content analysis was performed on 1,158 free descriptive responses obtained from 549 participants, which were categorized according to the content of decisions. Furthermore, 994 text data from 433 respondents to the quantitative questions were categorized according to the decisions' timing and examined in relation to medical and sociodemographic factors. RESULTS: Whereas more than 60% of medical decisions, except chemotherapy, were made before initial treatment, approximately more than one-third of sociopsychological decisions were made only after the initial treatment. In decisions regarding medical care, only surgical decisions showed an association between timing and the participants' decision-making style. Meanwhile, in decisions regarding sociopsychological matters, socioeconomic status at the time of diagnosis, such as marital and employment status, along with the perceived importance of what was to be determined, were associated with the timing of decision-making related to employment, attitudes toward life with BC, family matters and financial affairs. CONCLUSION: Women make various decisions depending on the amount of time since the diagnosis of BC. Generally, medical decisions are made prior to initial treatment, while these temporal characteristics are not observed for decisions relating to sociopsychological matters. Furthermore, socioeconomic status influences the timing of decision-making regarding sociopsychological matters. This finding can illustrate the manner in which to go through life with BC, and thus, help women who are unexpectedly diagnosed with BC to be more prepared.

What Japanese Women with Breast Cancer Decide: A Mixed Methods Analysis of Web-Based Open-Ended Responses.

BACKGROUND: Living with breast cancer (BC) involves making many decisions, which immediately follow the diagnosis of BC. These decisions concern not only medical care, but also sociopsychological aspects, suggesting that women with BC need a wide range of support. To understand the challenges Japanese women encounter following a diagnosis of BC, we holistically explored decisions women perceived themselves to have made following such a diagnosis. METHODS: This was a cross-sectional, internet-based study comprising open-ended question. Qualitative content analysis was employed on the 1158 free descriptive responses obtained from 549 participants. The frequencies of decisions were compared according to age at diagnosis using the chi-square test. RESULTS: Approximately 80% of the participants reported having made some decisions. These decisions were separated into 14 categories: two categories were related to medical care and 12 were related to sociopsychological decisions. The frequency of sociopsychological decisions was higher than that of medical care decisions. About two-thirds of participants reported having made more than two decisions, and about one-third reported having made both medical and sociopsychological decisions. The decisions made by women varied based on age group at diagnosis. The lower the age group at diagnosis, the higher was the frequency of decisions related to both medical care and sociopsychological matters. Participants who were diagnosed with BC at a younger age were more likely to encounter a greater number of sociopsychological decisions, such as those concerning employment, fatality, and marriage, compared with those who were diagnosed at an older age. CONCLUSIONS: This analysis of open-ended questions suggests that Japanese women diagnosed with BC have a wide range of support needs that vary according to their age group at diagnosis.

Work-Family Spillover, Job Demand, Job Control, and Workplace Social Support Affect the Mental Health of Home-Visit Nursing Staff.

The primary purpose of this study was to clarify the path by which high job demands on home-visit nursing staff affect their mental health through work-family negative spillover (WFNS, FWNS). The secondary purpose was to clarify the path by which high job control and high social support in the workplace positively affect the mental health of nursing home-visit staff through work-family positive spillover (WFPS, FWPS). A cross-sectional survey using a self-administered questionnaire was conducted on 1,022 visiting nursing staff working at 108 visiting nursing stations in Fukuoka Prefecture in February, 2019. The measurement tools comprised sociodemographic factors, the Japanese version of the Survey Work-Home Interaction - NijmeGen (SWING-J), Job Content Questionnaire (JCQ-22), the Work-Family Culture Scale, and the K6 scale. Six models were determined in an analysis of the model: (1) working time load → WFNS → FWNS → psychological distress, (2) job demands → WFNS → FWNS → psychological distress, (3) job demands → psychological distress, (4) workplace support → job control → WFPS → psychological distress, (5) workplace support → WFPS → psychological distress, and (6) workplace support → psychological distress. This study clarified that job demands and working time load may adversely affect the mental health of home-visit nursing staff through the mediation of WFNS. It was also clarified that high job control and workplace support may have a positive effect on mental health through the mediation of WFPS.

Correlates of regret with treatment decision-making among Japanese women with breast cancer: results of an internet-based cross-sectional survey.

BACKGROUND: Satisfaction with medical decisions among patients with cancer is associated not only with the results of decisions they make but also with how they make those decisions. To elucidate the decision-making process among Japanese women with breast cancer, we explored the correlates of regret with patients' treatment decision-making. METHODS: An Internet-based cross-sectional survey was utilized. Japanese women (N = 467) who self-reported that they had been diagnosed with stage 0-II breast cancer participated. Data regarding their decisional role (active, collaborative, or passive) in treatment decision-making, their most regrettable experience regarding their decision-making, the importance of various factors related to decision-making at the time, and clinical and sociodemographic factors were obtained. A forced-entry logistic regression analysis was performed on the likelihood that patients would have some regrets regarding the decision-making process. RESULTS: About half the women expressed some regret (51.4%). Women who had a mastectomy were significantly more likely to have regret than women who had breast conserving surgery. Correlates of regret differed by surgical type. For women who had a mastectomy, those who were aged ≥50 years when diagnosed, or who made their decisions collaboratively with their doctors were significantly less likely to have regret with the decision-making. For women who had breast conserving surgery, those who worked on a contract or part-time basis or whose decision-making roles matched their preferred role were significantly less likely to have regret. Among women who reported some regret, 23.8% expressed that their most regrettable experience concerned gathering information, while 21.3% regretted not consulting with others. For women who were diagnosed at a younger age, the influence on their sex life and pregnancy and childbirth was more important when making their treatment decisions than for women diagnosed an older age. CONCLUSIONS: Approximately half of the Japanese women with breast cancer in this study reported some regret in the treatment decision-making process. Effective participation in decision-making differed by surgical types. Additionally, women who are diagnosed with breast cancer at a relatively younger age, as compared to those who are older, may need additional information and support regarding their sex life and fertility after cancer treatment.

Congruence between Preferred and Actual Participation Roles Increases Satisfaction with Treatment Decision Making among Japanese Women with Breast Cancer

Objective: This study investigated the correlation between participation in the treatment decision-making process and satisfaction with the process among Japanese women with breast cancer. The influence of sociodemographic and clinical characteristics on satisfaction with the treatment decision-making process was also examined. Methods: We conducted a cross-sectional, self-administered internet survey of 650 Japanese women with breast cancer in March 2016. Decisional role (active, collaborative, passive) in the treatment decision-making was elicited using the Japanese version of the Control Preference Scale. Satisfaction with the decision-making process was assessed. Result: About half of the participants preferred to play a collaborative role, while half of the participants perceived that they played an active role. Satisfaction among the participants who made their treatment choice collaboratively with their physicians was significantly higher than that of participants who made the choice by themselves or entrusted their physicians to make the decision. However, two-way ANOVA demonstrated that satisfaction level was associated with the congruence between the participants' preferred and actual decisional roles, but not with the actual decisional roles that they played. This association had no interaction with sociodemographic and clinical status, except for education level. A majority of the participants who participated in the roles they preferred in choosing their treatment option indicated that they would participate in the same role if they were to face a similar decision-making situation in the future. Conclusion: Regardless of their role played in the cancer treatment decision-making process, and irrespective of their sociodemographic and clinical status, Japanese women with breast cancer are more satisfied with the treatment decision-making process when their participation in the process matches their preferred role in the process.

Effect of organizational factors and work environments on newly graduated nurses' intention to leave.

AIM: The purpose of this study was to investigate intention to leave in relation to organizational factors and work environments among newly graduated nurses (NGN). METHODS: A questionnaire was delivered to NGN (n = 762) from baccalaureate programs as well as diploma schools from 19 R-hospitals (R-hospitals were designated as "public medical institutions" by the 1951 Medical Law) in 2010. Spearman's rank correlation coefficients and Mann-Whitney U-test were used to test statistical significance. RESULTS: Only 148 questionnaires were returned for a return rate of 19.4%. The authors found that 8.1% of respondents had a highly to extremely likely desire to leave nursing. Intention to leave was significantly associated with Nursing Work Index total (P < 0.01), social support (P < 0.001), work barriers (P < 0.001), commitment to workplace (P < 0.001), job satisfaction (P < 0.001), and burnout (P < 0.001). Those who graduated from R-schools run by the R-organization had significantly positive impressions of their organizations and significantly lower intentions to leave compared to other graduates. CONCLUSION: The study results suggest that NGN intention to leave the workplace and nursing predict actual early intention to leave. In order to reduce burnout and turnover, support from colleagues and supervisors appears to be essential in organizational and psychosocial work environments for NGN to experience job satisfaction and be committed to their workplace. The results of this study also suggest that a longitudinal study is needed to reveal the long-term effects of organizational factors and work environments on NGN and how they impact role transition and adaptation of the NGN to professional practice roles.

Information-seeking experiences and decision-making roles of Japanese women with breast cancer.

PURPOSE: To investigate the information-seeking experiences and decision-making roles of Japanese women with breast cancer, to examine the relationship between information-seeking experiences and decision-making roles, and to explore the factors that influenced taking a more active role than the preferred role during the treatment decision-making process. METHODS: In a cross-sectional study, women with breast cancer were retrospectively administered the Control Preferences Scale and the Information-Seeking Experience Scale. The Chi-Square test was used to compare differences among individual variables in decision-making roles and information-seeking experiences. Logistic regression analysis was used to explore the factors that influenced taking a more active role than the preferred role. RESULTS: One hundred and four patients with breast cancer participated in the investigation. Eighty-five patients (78%) perceived themselves as having knowledge of breast cancer and most patients (92%) sought information on breast cancer. The preferred roles in decision-making that they reported having before treatment were 18% active, 69% collaborative and 13% passive. The actual roles they perceived having experienced were 27% active, 43% collaborative and 30% passive. Although there was concordance of preferred and actual role for only 59% of the women, most patients reported that they were satisfied with their decision-making. Many women with breast cancer reported negative experiences with information seeking, including wanting more information (49%), expending a lot of effort to obtain the information needed (53%), not having enough time to obtain needed information (55%), frustration during the search for information (44%), concerns about the quality of the information (45%) and difficulty understanding the information received (49%). This study revealed that having a more active actual role than the initial preferred role was associated with emotional expression to the physician, having undergone mastectomy, and the desire for more information. CONCLUSION: Most women with breast cancer sought information on breast cancer and expressed a preference for a collaborative relationship with physicians in treatment decision-making. Patients who expressed emotion to their physician, wanted more information, and underwent mastectomy were most likely to change their actual decision-making role toward a more active choice.