Qualitative assessment of information and decision support needs for managing menopausal symptoms after breast cancer.

PURPOSE: For breast cancer (BrCa) survivors, premature menopause can result from conventional cancer treatment. Due to limited treatment options, survivors often turn to complementary therapies (CTs), but struggle to make informed decisions. In this study, we identified BrCa survivors' CT and general information and decision-making needs related to menopausal symptoms. METHODS: The needs assessment was informed by interpretive descriptive methodology. Focus groups with survivors (n = 22) and interviews with conventional (n = 12) and CT (n = 5) healthcare professionals (HCPs) were conducted at two Canadian urban cancer centers. Thematic, inductive analysis was conducted on the data. RESULTS: Menopausal symptoms have significant negative impact on BrCa survivors. Close to 70 % of the sample were currently using CTs, including mind-body therapies (45.5 %), natural health products (NHPs) and dietary therapies (31.8 %), and lifestyle interventions (36.4 %). However, BrCa survivors reported inadequate access to information on the safety and efficacy of CT options. Survivors also struggled in their efforts to discuss CT with HCPs, who had limited time and information to support women in their CT decisions. Concise and credible information about CTs was required by BrCa survivors to support them in making informed and safe decisions about using CTs for menopausal symptom management. CONCLUSIONS: High quality research is needed on the efficacy and safety of CTs in managing menopausal symptoms following BrCa treatment. Decision support strategies, such as patient decision aids (DAs), may help synthesize and translate evidence on CTs and promote shared decision-making between BrCa survivors and HCPs about the role of CTs in coping with menopause following cancer treatment.

Sun-related behavior after a diagnosis of cutaneous malignant melanoma.

Cutaneous malignant melanoma is a significant public health problem in Western countries, and the probability that patients with one melanoma will develop a second one is high. This study is an attempt to assess and understand sun-related behavior in patients subsequent to a melanoma diagnosis. We recruited 35 melanoma patients diagnosed in 2001 or 2002, who resided in the Greater Vancouver Regional District of British Columbia, Canada, and 35 controls frequency matched by broad age-group, sex, ethnicity, and area of residence to patients. All participants were interviewed over the telephone in the autumn of 2003 to ascertain their outdoor activities for the previous summer months (June-August) of 2003, along with their clothing preferences, sunscreen use, sunburn frequency, and knowledge and attitudes regarding sun exposure and tanning. Patients were less involved in outdoor recreational activities than controls (mean monthly hours 23.0 vs. 31.0, P=0.023). In addition, patients protected themselves from sun exposure using clothing and sunscreen more often than controls. However, the data also revealed that patients still engaged in outdoor activities to a substantial degree, often without sun protection. Furthermore, 27% still had a positive or neutral attitude toward tanning, even after melanoma diagnosis. The continuing presence of unprotected episodes of summer sun exposure in patients with melanoma, coupled with sunburn prevalence similar to normal controls, suggests that better education and behavior modification programs are needed for patients with melanoma. The results may indicate the need for more emphasis on post-treatment counseling by physicians.

The influence of significant others in complementary and alternative medicine decisions by cancer patients.

Individuals living with cancer are faced with numerous treatment decisions that encompass both conventional therapies and complementary and alternative medicine (CAM). Although a beginning body of research has explored the CAM decision-making process by cancer patients, the social context of these treatment decisions has been largely ignored. As a part of a larger grounded theory research project exploring CAM decision-making processes of cancer patients living in British Columbia, Canada, the purpose of this secondary inquiry was to explore how significant others were involved in patients' decisions related to CAM. In total, 61 patients with early and advanced-stage breast and prostate cancer and 31 significant others participated in semi-structured interviews. Using constant comparative analysis, four main types of decisional involvement by significant others were identified: creating a safe place for the patient to make a decision, "becoming a team": collaborative decision-making, moving the patient towards a decision, and making the decision for the patient. Significant others were often found to engage in more than one type of decision involvement as a consequence of several key factors. Within the types of decisional involvement, nine distinct roles in the CAM decision-making process were described by the significant others. The findings of this inquiry extend previous research by highlighting the importance of significant others in cancer patients' CAM decisions and challenge past conceptualizations of autonomy in treatment decision making.