Breast Cancer Screening Paved with Good Intentions: Application of the Information-Motivation-Behavioral Skills Model to Racial/Ethnic Minority Women.

Racial/ethnic minority women experience disparities in breast cancer. Studies suggest that this may be partly related to later stage of diagnosis. Adherence to breast cancer screening guidelines is frequently lower in racial/ethnic minority populations, which may contribute to this disparity. The purpose of this study was to examine the predictors of intentions to obtain breast cancer screening based on established guidelines using the information-motivation-behavioral skills model. Data for this study were obtained from the community-based Kin KeeperSM Cancer Prevention Intervention study and included 278 racial/ethnic minority women (Black = 138; Latina = 68; Arab = 80). Data were collected between 2009 and 2010 and analyzed in 2013. Structural equation models were tested to examining the effects of functional breast cancer literacy, motivation, and breast cancer screening behavior. Motivation was significantly associated with breast cancer screening. Breast cancer literacy (information) is positively associated with breast cancer screening. The findings indicate that the higher the level of breast cancer literacy and the more motivated patients are, the more likely they are to be screened. In addition, there was a significant association between the covariate race and other model constructs. Functional breast cancer literacy and motivation interventions are important factors to consider when designing breast cancer screening interventions in racial/ethnic minority women. These interventions should consider cultural and contextual factors that are associated with screening behavior.

Reducing Racial Disparities in Breast Cancer Survivors' Ratings of Quality Cancer Care: The Enduring Impact of Trust.

PURPOSE: Patient satisfaction provides an important illumination of the quality of care that is delivered. Satisfaction with care is often lower in Black women compared with their non-Hispanic White counterparts. Data are lacking regarding quality ratings of breast cancer patients. We examined racial disparities in ratings of the quality of cancer care in newly diagnosed Black (n = 217) and White (n = 152) patients. METHODS: This was a cross-sectional observational study. Patients were recruited through hospitals and community outreach. Women with primary invasive, nonmetastatic breast cancer were eligible. Trained interviewers administered a standardized survey through telephone; clinical data were abstracted from medical records. The primary outcome, healthcare quality, was assessed using the PSQ-18, which assessed patients' ratings regarding four healthcare domains: interpersonal care, financial issues, technical ratings of physicians, and access and convenience. Independent variables included healthcare factors (e.g., suspicion toward the healthcare system), psychosocial factors (e.g., physicians' solicitation behaviors), and socioeconomic factors (e.g., limited access to resources). Multiple linear regression was used to evaluate associations between each healthcare quality domain and independent variables. RESULTS: In univariate analysis, Black women reported lower ratings for four domains: technical (Black m = 3.99; White m = 4.26; p < .001), interpersonal (Black m = 4.15, White m = 4.35; p < .01), financial (Black m = 3.81, White m = 4.0, p < .001), and access and convenience (Black m = 3.92, White m = 4.08, p < .01). After adjusting for healthcare characteristics and psychosocial factors, trust in providers was significantly associated with three domains (ß = 0.085, p < .001, technical; ß = 0.066, p < .0001, interpersonal; ß = 0.043, p < .0001, financial). CONCLUSION: Racial disparities in ratings of healthcare quality were diminished across several domains after controlling for psychosocial and healthcare factors. Strategies aimed at improving self-efficacy in women with higher levels of mistrust may improve patient satisfaction.

Impact of Age and Comorbidity on Cervical and Breast Cancer Literacy of African Americans, Latina, and Arab Women.

This study examines the relationship between age, comorbidity, and breast and cervical cancer literacy in a sample of African American, Latina, and Arab women (N = 371) from Detroit, Michigan. The Age-adjusted Charlson Comorbidity Index (ACC) was used characterize the impact of age and comorbidity on breast and cervical cancer literacy. The relationship between ACC and breast and cervical cancer screening, and group differences, were assessed. There was a statistically significant difference between breast cancer literacy scores. ACC had a greater impact on breast cancer literacy for African Americans.

Cognitive Reserve and Physical Function in Older African-Americans.

This study examined the relationship between cognitive reserve and physicalfunction in older African-Americans. The concept of cognitive reserve postulates that aspects of life experience (e.g., education, occupational complexity, leisure activity, and socioeconomic status) may provide cognitive reserve, in theform of a set of skills or repertoires, that allow some people to cope better than others with illness and alter the clinical expression of decline in functional status. This study used a descriptive correlational design. Physicalfunction was assessed with the SF-36 (physicalfunction subscale). The mean scorefor the SF-36 PF subscale was 47 (SD = 10), indicating that the participants had good physical functioning. Physical function was associated with occupational complexity, educational attainment, and income. The study provides baseline data about the relationship between cognitive reserve and physicalfunction.

A pilot study of the self-reported quality of life for patients with chronic obstructive pulmonary disease.

BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) experience significant impairment in their quality of life (QOL). However, relatively few studies have examined overall and global QOL in patients with COPD using both generic QOL and health-related quality of life (HRQOL) measures. PURPOSE: The purposes of this pilot study were to describe the self-reported QOL (overall and global), disease-specific HRQOL, depressive symptoms, and disease-specific symptoms and experiences of patients with COPD and to examine the relationship among disease-specific HRQOL, depressive symptoms, disease-specific symptoms and experiences, and QOL (overall and global) in patients diagnosed with moderate to severe COPD. METHODS: A descriptive correlational design was used. Thirty-six participants completed overall QOL, global QOL, disease-specific HRQOL, depressive symptoms, and disease-specific symptoms and experiences questionnaires. RESULTS: Overall QOL was low; global QOL was at the median of scale range. Overall QOL scores were significantly correlated with the disease-specific St George Respiratory Questionnaire total score, symptoms and impact subscale, depressive symptoms, and 7 Bronchitis Emphysema Symptom Checklist subscales. CONCLUSION: Findings provided partial support for the association between QOL and disease-specific HRQOL and the usefulness of disease-specific questionnaires when assessing QOL.

AANA Journal course. Update for nurse anesthetists. Evaluation of older adults.

As life expectancy increases, the anesthetic management of older surgical patients has received increased attention. Current estimates suggest that approximately 20% or more of the surgical procedures performed in the United States are on persons 65 years or older, and if current trends continue, the number of older patients requiring anesthesia for surgical procedures is likely to increase. A thorough evaluation is required when planning for the anesthetic management of older adults. Older adults have specific management needs, and these demands continue to pose challenges to anesthesia providers. These challenges relate to the accrual of numerous and diverse anatomic and physiologic changes that occur in older adults throughout the course of aging.