Nurses' attitudes toward clinical trials at a comprehensive cancer center.

PURPOSE/OBJECTIVES: To identify nurses' attitudes and beliefs toward cancer clinical trials and their perceptions about factors influencing patients' participation in these trials. DESIGN: Descriptive. SETTING: National Cancer Institute-designated comprehensive cancer center. SAMPLE: 417 nurses employed at the cancer center were surveyed; 250 (60%) subjects responded. METHODS: 59-item questionnaire. MAIN RESEARCH VARIABLES: Nurses' attitudes toward clinical trials and perceptions of patient understanding of and influences on participation in clinical trials. FINDINGS: 96% of nurses reported that participation in clinical trials is important to improving standards of care; only 56% believed that patients should be encouraged to participate in trials if they had cancer. In multiple regression analyses, older age and being a research nurse were significant predictors of positive attitudes toward clinical trials. Work setting also was a significant predictor of nurses' perceptions of patients' understanding of treatment. Overall, nurses reported that an investigational therapy should have at least a 50% chance of success prior to being offered to patients. CONCLUSIONS: Nurses generally reported that clinical trials are important to improve standards of care; however, attitudes concerning patient participation in clinical trials and perceptions of patient understanding differed by work setting. Nurses have high expectations regarding the benefits of investigational therapy. IMPLICATIONS FOR NURSING PRACTICE: Nurses play a critical role in the care of participants in cancer clinical trials. Targeted interventions that involve nurses to enhance appropriate patient accrual, patient understanding, and patient decision making should result in improved patient care in centers conducting clinical trials.

Factors that influence a patient's decision to participate in a phase I cancer clinical trial.

PURPOSE/OBJECTIVES: To explore factors that influence an individual's decision to participate in phase I cancer clinical trials. DESIGN: Exploratory, descriptive, and qualitative study. SETTING: Outpatient oncology clinic of a comprehensive cancer center in an urban setting. SAMPLE: 22 patients with cancer who had been asked at some point during their treatment to participate in a phase I cancer clinical trial were invited to participate in a focus group. Eight patients participated. METHODS: Two focus groups were conducted. MAIN RESEARCH VARIABLES: Factors that influenced patients' decisions to participate in a phase I cancer clinical trial. FINDINGS: Participants expressed that hope for a cure and trusting the oncologist's advice were the primary factors that influenced their decisions to participate in phase I research. The majority expressed surprise that anyone would participate in an experimental study for altruistic reasons. CONCLUSIONS: Patients choose to hope for some personal benefit from their participation in phase I clinical trials even though they realized that is not the purpose or goal of the trial. IMPLICATIONS FOR NURSING PRACTICE: Nurses are in an ideal position to offer information to individuals who are deciding whether to participate in a phase I cancer clinical trial. However, most nurses are not seizing this opportunity. Patients are unable to describe nurses' impact on their decision to enter a phase I cancer clinical trial.

Impact of quality of life on patient expectations regarding phase I clinical trials.

PURPOSE: Quality of life (QOL) is increasingly recognized as a critical cancer-treatment outcome measure, but little is known about the impact of QOL on the patient decision-making process. A pilot study was conducted in an effort to (1) measure the expectations of patients, physicians, and research nurses regarding the potential benefits and toxicities from experimental and standard therapies, and (2) determine the relationship of QOL to patient perceptions regarding treatment options. METHODS: Thirty cancer patients enrolling in phase I clinical trials, their physicians, and their research nurses were administered questionnaires that assessed demographics, QOL, and treatment expectations. RESULTS: Compared with their physicians, patients overestimated potential benefits and toxicities from experimental therapy (mean expected benefit, 59.8% v 23.8%, P <.01; mean expected toxicity, 29.8% v 16.0%, P <.01). Patients estimated a greater potential for benefit (59.8% v 36.8%, P <.01) and less potential for toxicity (29.8% v 45.6%, P =.01) for experimental therapy, compared with standard therapy. Short Form-36 general health perception correlated with patient perception of potential benefit from experimental therapy (r =.48, P =.01). CONCLUSION: Participants in phase I clinical trial have high expectations regarding the success of experimental therapy and discount potential toxicity. Patient QOL may affect the expectation of benefit from experimental therapy and, ultimately, treatment choice. Understanding the interactions between QOL and patient expectations may guide the development of improved strategies to present appropriate information to patients considering early-phase clinical trials.

Patterns of breast cancer screening among lesbians at increased risk for breast cancer.

BACKGROUND: Women with a family history of breast cancer (i.e., in a mother, sister or daughter) are at increased risk for this disease. Previous data also suggest that lesbians are at increased risk for breast cancer. While the screening behaviors of women with a family history have been described, little is known about factors that influence screening behaviors of lesbians with the same risk factor profile. PURPOSE: The purpose of this study was to characterize the perceptions of susceptibility to breast cancer and describe factors that influence adherence to breast cancer screening guidelines in a sample of lesbians with a first-degree relative with a diagnosis of breast cancer. METHODS: Structured telephone interviews were conducted on a sample of 139 self-identified lesbians who had a first-degree relative with a diagnosis of breast cancer, were between the ages of 35 to 75 and had no previous history of cancer. Cross-sectional data obtained, included socio-demographics, breast cancer risk factors, breast cancer screening patterns, breast cancer perceptions, worries, and knowledge, and barriers and access to health care factors. Individual subject characteristics were examined for their association with adherence to mammography guidelines followed by a multivariate analysis to evaluate the most important combinations of factors. Outcome measures were age-specific adherence to ACS guidelines for both mammography and overall adherence (i.e., mammography, clinical breast examination and breast self-examination). RESULTS: The 139 lesbians interviewed for this study were young (mean age = 43), almost exclusively white (94%), highly educated (78% = college graduate and beyond), and partnered (68%). In the bivariate analysis of individual factors, being employed and reporting breast cancer worries were significantly and positively associated with adherence to mammography guidelines. Higher income and insurance type were significantly associated with mammography adherence. No factors were significantly associated with overall adherence. Multivariate logistic regression analyses revealed that only income level and degree of breast cancer worries were significantly and positively associated with mammography adherence. However, since there was a high correlation between income level and employment status, a regression model with employment status and worry was also significantly related to mammography adherence. CONCLUSIONS: In lesbians who are at an increased risk for breast cancer because of family history, breast cancer worries may motivate, rather than deter, adherence for mammography use. High income levels also appear to enable adherence in this population. IMPLICATIONS: Additional studies are needed to validate these findings, identify the prevalence of lesbians in general samples of women at increased risk for breast cancer, and prospectively test lesbian sensitive educational intervention strategies designed to facilitate adherence to mammography screening guidelines in this population.

Interdisciplinary education in clinical ethics: a work in progress.

Clinical decision making and, broadly speaking, patient care are increasingly collaborative endeavors dependent on the integration of the profession-specific knowledge, skills, and perspectives of physicians and nurses. Conflicts over the ethical dimensions of clinical decision making often arise from these differing but complementary perspectives. Neither medical nor nursing education adequately prepares future clinicians for these realities of practice. At Georgetown University, students and faculty in medicine and nursing have developed an interdisciplinary curriculum in clinical ethics. The curriculum will bring together medical students and graduate nursing students with the aim of educating and training them to analyze and resolve dilemmas in clinical ethics critically and collaboratively.

Choosing reconstruction after mastectomy: a qualitative analysis.

PURPOSE/OBJECTIVES: To describe women's perspectives on factors that influenced their decision to have reconstructive surgery after a breast cancer diagnosis. DESIGN: Exploratory, descriptive, qualitative study. SETTING: A comprehensive cancer center in an urban setting. SAMPLE: Eleven women who underwent mastectomy and reconstruction. Six participants had autologous transverse rectus abdominis musculocutaneous-flap reconstruction, four had saline implants, and one had a silicone implant. All but one reconstruction was performed at the time of mastectomy. METHODS: Open-ended, face-to-face interviews using an interview guide were conducted within one month of reconstruction. One to two follow-up interviews were conducted approximately six months later. MAIN RESEARCH VARIABLES: Decision making about reconstruction, perceptions of information needs and sources, sources of support, and factors important to decision making. FINDINGS: The main theme identified was Getting My Life Back. The participants described this in terms of the themes of Information Seeking, Talking It Over, and Seeking Normality. The interactive skills of the healthcare provider played an important role in the women's decision making. CONCLUSIONS: Reconstruction minimized the negative consequences of breast cancer and its treatment for the women in the study. The decision-making process was aimed at getting the person's life back as close to what it was before the diagnosis as possible or improving it. The three themes of decision making are interactive in nature, with participants returning to information Seeking and Talking It Over as necessary to increasing their understanding and clarifying their "normality goals." IMPLICATIONS FOR NURSING PRACTICE: Healthcare professionals should determine how a woman wants to participate in decision making as well as the kind, amount, and sources of information the individual with breast cancer wants to have to make her decisions. Healthcare providers are key sources of information about treatment options, and they are critical to patient satisfaction with the decision-making process and with the final results of the surgical procedure. Family members, friends, and other women with breast cancer play a crucial role in talking it over.

Coping responses to the diagnosis of breast cancer in postmastectomy patients.

PURPOSE: This study examined coping responses in women diagnosed with Stage I or Stage II breast cancer. METHODS: A convenience sample of 36 patients with breast cancer was administered the Reaction to Diagnosis of Cancer Questionnaire (RDCQ) at 2 days and 30 days postmastectomy. RESULTS: No statistically significant differences were observed in RDCQ scores between 2 days and 30 days postmastectomy (t = -1.57, P = 0.127). However, a significant change in the mean difference of the RDCQ scores was observed in women who had immediate breast reconstruction when compared to those women who did not have reconstruction (t = -2.34, P = 0.037). Additional results indicated that age and RDCQ scores had an inverse relationship, and women who were employed had significantly lower RDCQ scores at 30 days postmastectomy, indicating less positive coping. The variables of marital status, educational level, and number of days since diagnosis were not significant. CLINICAL IMPLICATIONS: The results of this study may assist healthcare providers in understanding what affects coping in women diagnosed with early stage breast cancer.

Barriers to breast and cervical cancer screening in underserved women of the District of Columbia.

PURPOSE/OBJECTIVES: To identify barriers to breast and cervical cancer screening services from the perspective of medically underserved women of the District of Columbia (DC) that may influence intentions to perform breast and cervical cancer screening behaviors; to determine any relationship between attitudes and influence of significant others on intended behaviors; and to identify a relationship between the site where services are provided and the underserved women's intentions to engage in screening behaviors. DESIGN: Cross-sectional, correlational. SETTING: Breast and cervical cancer screening clinics in DC. SAMPLE: 339 medically underserved, adult women. METHODS: Face-to-face investigator-conducted interviews. MAIN RESEARCH VARIABLES: Demographic and contextual variables as well as attitudes and influence of significant others. Intention to have a mammogram or Pap test or perform breast self-examination (BSE) monthly. FINDINGS: Intention to have a mammogram was positively related to influence of significant others and negatively related to uncaring healthcare professionals. Intention to have a Pap test had a positive relationship with one's attitude toward the test and with the influence of significant others. Intention to perform BSE was positively related to attitude toward and previous performance of BSE and influence of significant others. No significant relationships were observed between intention to perform screening behaviors and demographic variables. CONCLUSIONS: Factors that influence women's attitudes toward screening and intention to perform these behaviors include previous screening behaviors, influence of significant others, and relationships with healthcare professionals. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses are well-positioned to develop and test intervention strategies designed to increase access to and compliance with recommended screening guidelines among the medically underserved. Findings from this study potentially could guide development and evaluation of such strategies that are sensitive to this special population.