Treatment experiences of Latinas after diagnosis of breast cancer

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138310/1/cncr30702.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138310/2/cncr30702_am.pd

Cancer

ObjectivesWe examined race/ethnic differences in patient perspectives about their breast cancer treatment experiences.MethodsA weighted random sample of women newly diagnosed with breast cancer in 2013\u201315 in Los Angeles County and Georgia were sent surveys 2 months after surgery (N=5,080, 70% response rate). The analytic sample was limited to patients in Los Angeles County (N=2,397).ResultsThe pattern of visits with different specialists before surgery was similar across race/ethnic groups. Low acculturated Latinas (Latinas-LA) were less likely to report high clinician communication quality for both surgeons and medical oncologists (under 69% vs over 72% for all other groups, p<.05). The proportion of patients who reported high satisfaction about how doctors worked together was similar across race/ethnic groups. Latinas-LA were more likely to have a low autonomy decision style (48% vs 24%\u201350% for all other groups, p<.001) and were more likely to report getting too much information vs other ethnic groups (20% vs <16% for other groups, p<.001). Patients who reported a low autonomy decision style were more likely to rate amount of information received for the surgery decision as \u201ctoo much\u201d (16% vs 9%, p<.001).ConclusionsThere is moderate disparity in breast cancer treatment communication and decision making experiences reported by Latinas with low acculturation vs other groups. The approach to treatment decision making by Latinas with low acculturation represents an important challenge to health care providers. Initiatives are needed to improve patient engagement in decision-making and increase clinician awareness of these challenges in this patient population.HHSN261201000140C/CA/NCI NIH HHS/United StatesHHSN261201000035C/CA/NCI NIH HHS/United StatesP01 CA163233/CA/NCI NIH HHS/United StatesU58 DP003875/DP/NCCDPHP CDC HHS/United StatesHHSN261201300015C/RC/CCR NIH HHS/United StatesHHSN261201000035I/CA/NCI NIH HHS/United StatesHHSN261201000034C/CA/NCI NIH HHS/United StatesU58 DP003862/DP/NCCDPHP CDC HHS/United States2018-08-15T00:00:00Z28398629PMC5544545vault:2385

JAMA Surg

IMPORTANCEGuidelines assert that CPM should be discouraged in patients without an elevated risk of a second primary breast cancer. However, little is known about the impact of surgeons discouraging CPM on patient care satisfaction or decisions to seek treatment from another clinician.OBJECTIVEWe examined the association between patient report of first surgeon recommendation against CPM and the extent of discussion about it with 3 outcomes: patient satisfaction with surgery decisions, receipt of a second opinion, and receipt of surgery by a second surgeon.DESIGN, SETTING, and PARTICIPANTSThis population-based survey study was conducted in Georgia and California. We identified 3880 women with stages 0 to II breast cancer treated in 2013\u20132014 through the Surveillance, Epidemiology, and End Results registries of Georgia and Los Angeles County. Surveys were sent approximately 2 months after surgery (71% response rate; n=2578). In this analysis conducted from February to May 2016, we included patients with unilateral breast cancer who considered CPM (n=1,140). Patients were selected between July 2013 and September 2014.PRIMARY OUTCOME AND MEASURESWe examined report of surgeon recommendations, level of discussion about CPM, satisfaction with surgical decision-making, receipt of second surgical opinion, and surgery from a second surgeon.RESULTSThe mean (SD) age of patients in this study was 56 (10.6) years. About one-quarter of patients (26.7%; n=304) reported that their first surgeon recommended against CPM and 30.1% (n=343) reported no substantial discussion about CPM. Dissatisfaction with surgery decision was uncommon (7.6%; n=130), controlling for clinical and demographic characteristics. One-fifth of patients (20.6%; n=304) had a second opinion about surgical options and 9.8% (n=158) had surgery performed by a second surgeon. Dissatisfaction was very low (3.9%; n=42) among patients who reported that their surgeon did not recommend against CPM but discussed it. Dissatisfaction was substantively higher for those whose surgeon recommended against CPM with no substantive discussion (14.5%; n=37). Women who received a recommendation against CPM were not more likely to seek a second opinion (17.1% among patients with recommendation against CPM vs 15.1% of others, p=.52) nor to receive surgery by a second surgeon (7.9% among patients with recommendation against CPM vs 8.3% of others, p=.883).CONCLUSION AND RELEVANCEMost patients are satisfied with surgical decision making. First-surgeon recommendation against CPM does not appear to substantively increase patient dissatisfaction, use of second opinions, or loss of the patient to a second surgeon.HHSN261201000140C/CA/NCI NIH HHS/United StatesHHSN261201000035C/CA/NCI NIH HHS/United StatesP01 CA163233/CA/NCI NIH HHS/United StatesU58 DP003875/DP/NCCDPHP CDC HHS/United StatesHHSN261201300015C/RC/CCR NIH HHS/United StatesHHSN261201000035I/CA/NCI NIH HHS/United StatesHHSN261201000034C/CA/NCI NIH HHS/United StatesU58 DP003862/DP/NCCDPHP CDC HHS/United States2018-07-01T00:00:00Z28384687PMC5520628vault:2615

The association between patient attitudes and values and the strength of consideration for contralateral prophylactic mastectomy in a population‐based sample of breast cancer patients

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140052/1/cncr30924_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/140052/2/cncr30924.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/140052/3/cncr30924-sup-0002-suppinfo.pd

Supporting Physical Activity in Pregnancy

Physical activity is considered a key therapy for reducing obstetric complications, yet more than 3 in 4 individuals fail to meet physical activity recommendations during pregnancy (Gaston & Vamos, 2012). Differing approaches to physical activity counseling have been implemented to address this issue (Pearce et al., 2013). This study aimed to investigate the effect of one such counseling method, termed motivational interviewing (MI; Miller & Rollnick, 2013). It involved two approaches for communicating physical activity information – a guiding style embodying the autonomy-supportive mindset of MI, or a directing style involving specific advice and recommendations. Each of these approaches was depicted through a written vignette, showcasing a consult between an exercise professional and a pregnant client. Based on random assignment, participants (N = 123) read one of the two vignettes, then indicated the vignette client’s physical activity level for three time points post-consult. Participants assigned to the guiding style (n = 56) reported higher scores on the six manipulation check items compared to those assigned to the directing style (n = 67). While the mixed model ANOVA demonstrated no significant group × time interaction effect, the analysis revealed a significant main effect of group and time on physical activity levels. Specifically, those in the guiding style condition reported more physical activity on average than those in the directing style condition, with levels decreasing over time in both groups. In sum, a guiding communication style, generated in accordance with MI-based evidence, shows promise for improving prenatal physical activity levels and merits further investigation

Stress, appraisal, autonomous support and coping: an integrative perspective of adult type 2 diabetes management in Newfoundland and Labrador

In the present study, data was collected from 165 adult type 2 diabetes patients in Newfoundland and Labrador to understand their psychosocial behaviour associated with blood glucose (HbA1c). Patient characteristics and the effect of four types of psychosocial behaviour on HbA1c are examined. A high prevalence of poor glycemic control is found in the participants having BMI ≥ 35. The participants with higher stress have a negative appraisal of diabetes. The highly stressed group has a tendency to use emotion-oriented coping and to have a poor perception of autonomous supportiveness. Two path models are developed conducting regressions analyses. The first one shows that stress, appraisal and coping can explain 7.4% of the variance in HbA1c. The second path model shows that appraisal plays a role of mediator and can explain 5.8% of the variance in HbA1c. Finally, 50.4% of the variance in stress can be explained by appraisal, coping and autonomous perception

Strategies Outpatient Health Care Executives Use to Reduce Physician Turnover

Some outpatient health care executives experience high physician turnover leading to increased costs. To retain highly productive physicians, outpatient health care executives need to understand the best strategies for reducing physician turnover. Grounded in Herzberg 2-factor theory as the conceptual framework, the purpose of this multiple case study was to explore the strategies outpatient health care executives used to reduce physician turnover. Data were collected from semistructured interviews of 4 outpatient health care executives and the review of proprietary documents from 2 outpatient health care facilities in the Southern California metropolitan area. Data analysis comprised compiling and disassembling the data into common codes, reassembling the data into themes, interpreting the themes, and reporting the themes. Member checking and methodological triangulation amplified the trustworthiness of the findings. The course of thematic analysis led to identification of 4 core themes: autonomy, satisfactory work environment, effective communication, and training and growth opportunity. Implications for positive social change include the potential to increase economic growth while benefitting employees, families, and communities; increasing the continuity of patient care; and increasing patients\u27 access to health care. Outpatient health care executives can use the results of this study to implement changes conducive to minimizing physician turnover and associated costs while enhancing the quality of health care

Occupational therapy leadership: promoting an autonomy-supportive environment based on self-determination theory, to improve patient outcomes in acute and post-acute stroke rehabilitation

A major dilemma that is being addressed in the current project is the discrepancies between healthcare system's expectations for a rapid and successful rehabilitation process and patients after having a stroke ability to meet these expectations while striving to adapt to the calamitous event in their life. Emphasizing a more biomedical approach and under implementation of psychosocial approaches, poor acknowledging of patients' basic psychological needs lead to poor motivation, therapeutic disengagement and may lead to a rehabilitation failure. To cope with this gap in the process of stroke rehabilitation, an educational program aiming for occupational therapists working with patients after having a stroke in their acute and post-acute rehabilitation phases was constructed. The program guides practitioners for effective communication with their patients, building a needs-supportive environment and addressing their patients' basic psychological needs in light of the selfdetermination theory, theories of adaptation from occupational therapy perspectives and considering occupational justice and the ICF model. A clinical reasoning, step-by-step problem solving is introduced using adaptation of known models and innovated models for interventions that were created for this purpose. Program delivery through a series of 4-webinar modules is illustrated with their learning objectives, assignments and discussions. The program evaluation and implementation are expected to be the initiator of a change in the health and rehabilitation climate and in Israel