Correlates of reduced exercise behaviour in depression: the role of motivational and volitional deficits.

OBJECTIVE: The study aimed at uncovering the correlates of reduced exercise in depressive patients. On the basis of the Health Action Process Approach (Schwarzer, 2011 ), we hypothesised that reduced exercise in depressive patients can be explained by motivational deficits and volitional deficits. DESIGN: A longitudinal sample of 56 clinically depressive outpatients was compared to a sample of 56 parallelised non-depressive controls. MAIN OUTCOME MEASURES: Self-reported intention, exercise, and motivational and volitional HAPA variables were measured with self-report questionnaires at baseline and four-week follow-up. RESULTS: Depressive patients showed a motivational deficit: they had significantly reduced intentions to exercise compared to non-depressive participants, and they suffered from reduced self-efficacy and increased negative outcome expectations. No differences were found with regard to positive outcome expectations. Depressive patients also showed a volitional deficit: depressive high-intenders were less capable of transforming their intention into action than non-depressive high-intenders. They produced less action plans, had less maintenance self-efficacy and were more easily distracted by barriers. CONCLUSION: The lower level of exercise among depressive patients is partly due to motivational, partly to volitional deficits. Interventions should be stage-matched and should focus on pessimistic beliefs (negative outcome expectations, self-efficacy) and planning deficits in depression.

Patients' needs and experiences at breast cancer diagnosis: how perceived threat influences the physician-patient interaction.

Physician-patient interaction at breast cancer diagnosis can only succeed if physicians know what patients want. To investigate patients' needs and experiences we conducted semistructured interviews with eight patients. Verbatim transcripts were analyzed according to grounded theory and a typological approach. Patients' needs and experiences concurred with a patient-centered approach in many aspects. The threat perceived by patients following diagnosis strongly influenced their needs and experiences. Three different types of patients were identified: emotionally needy, active, and trustful, adaptive. The typology identified in this study may help physicians to adequately adapt their behavior.

Communication matters: the impact of communication and participation in decision making on breast cancer patients' depression and quality of life.

OBJECTIVE: This study explored the impact of breast cancer patients' experiences of physician-patient communication and participation in decision making on patient depression and quality of life three and six months after primary treatment. METHODS: Participants were 135 German breast cancer patients, recruited within a week after the beginning of treatment. Women were asked to complete a self-administered questionnaire at baseline and three and six months later. RESULTS: Patients who rated their level of information at baseline as high were less depressed after three (p=.010) and six months (p<.001) and experienced higher quality of life after three (p<.001) and six months (p=.049). Patients who participated as much as they had wanted were more satisfied with the decision making process (p<.001) and had lower depression scores three months later (p=.005). The level of participation itself (passive, collaborative, active) and the treatment type had no impact. CONCLUSION: The findings reveal the significance of physician-patient communication and stress the meaning of baseline depression for later adjustment. PRACTICE IMPLICATIONS: A high level of information and tailoring the involvement in decision making to patients' desired level can help patients to better cope with their illness. Physicians should assess and treat depression early in cancer treatment.

Information and decision making: patients' needs and experiences in the course of breast cancer treatment.

OBJECTIVE: This study explored breast cancer patients' preferences and experiences in receiving information and decision making in the course of the first 6 months of cancer treatment. METHODS: Participants were 135 German breast cancer patients, recruited within a week of either surgery or the beginning of neo-adjuvant chemotherapy. Women were asked to complete a self-explanatory questionnaire at baseline and 3 and 6 months later. RESULTS: There was a significant decrease in the importance of specific information needs. The quality of received information through the physician was rated significantly better at baseline than 6 months later. Nearly half of all patients changed their decision making preference at least at one assessment point. Shared decision making rarely took place in the first 6 months of treatment. CONCLUSION: Breast cancer patients' information needs and decision making preferences can change during treatment. Future research should analyse which patients change their decision making preference under which circumstances. PRACTICE IMPLICATIONS: Physicians need to investigate the decision making preferences and information needs of their patients in the course of treatment. Patient oriented communication skills might be helpful to meet patients' preferences and needs.

Concordance between patients' desired and actual decision-making roles in breast cancer care.

This study explored breast cancer patients' preferences and experiences for participation in treatment decision making as well as the concordance between patients' actual and desired decision making. The interplay between depression, anxiety and decision-making preferences was also examined.A consecutive sample of primary breast cancer patients was recruited within a week of either surgery or the beginning of neo-adjuvant chemotherapy in two breast cancer centres in Germany. Women were asked to complete a self-explanatory questionnaire. Most patients (40.2%) of the 137 participants preferred the physician to make the treatment decision. A total of 63.4% were able to fulfil their preferred decision-making role. Breast cancer patients who wanted the physician to make the decision and patients who wanted to make the decision on their own were more likely to have their preferences met than patients who wished to share the decision (p < 0.01). Availability of treatment choice and the level of depression influenced the preferred decision-making preference. Limited concordance between desired and actual decision making of patients with collaborative decision-making preferences suggests the need for better communication and physician training on shared decision making.

Results of a randomized study of telephone versus in-person breast cancer risk counseling.

OBJECTIVE: Women of all risk levels have reported high interest in obtaining genetic testing for breast cancer risk. Breast cancer risk counseling may help women to learn about their risk and appropriate options of testing. This study measured the effects of an intervention in-person and by telephone, compared to a control group. METHODS: Participants were 340 women, recruited through a network of primary care physicians. They received a baseline questionnaire in the mail, were randomized to one of the three study arms, and completed a follow-up survey 3 months later. RESULTS: Both types of counseling were very well received. The counseling decreased women's cancer worry, risk perceptions, and intentions to pursue genetic testing. There were similar effects for both in-person and telephone counseling. CONCLUSION: Genetic counseling can be used to inform women at all risk levels about their breast cancer risk. PRACTICE IMPLICATIONS: Breast cancer risk counseling can be done in-person and by telephone--thereby reaching women in remote areas.

Application of the protection motivation theory to genetic testing for breast cancer risk.

BACKGROUND: Many women, even women at low risk, are interested in genetic testing for breast cancer risk. However, the test has little to offer for women at low to moderate risk. We applied the Protection Motivation Theory (PMT) to investigate predictors of women's motivation to obtain such a test. METHODS: Women at low to moderate risk (n = 330) were recruited through a physician network. They received an informational letter by mail and completed a telephone survey and a written baseline questionnaire. RESULTS: Structural equation analyses with motivation to test as the outcome variable showed that the full model was not supported by the data. However, modifications to the model resulted in good model fit and explained 51% of the variance. Women with increased breast cancer worries, which were influenced by perceived risk, and women who saw more disadvantages of not getting tested showed more motivation to pursue testing. Women who saw more advantages of not getting tested showed less motivation. CONCLUSIONS: Applying the PMT was helpful in determining factors that play a role in women's intentions to obtain genetic testing. Counseling should aim at decreasing perceived risk and breast cancer worries and include a discussion of the consequences of not getting tested.

Patient preferences of decision-making in the context of genetic testing for breast cancer risk.

PURPOSE: We conducted a study on women's preferred physician involvement in the decision to obtain genetic testing for breast cancer risk. METHODS: Women from a primary care physician network completed a telephone survey and a written baseline questionnaire. RESULTS: The majority preferred to make up their own minds. Predictors of leaving the decision to providers were less education, less knowledge, and higher external health locus of control. Trust in one's physician mediated the effect of health locus of control on decision method. CONCLUSION: Physicians will face requests from low-risk women and will need effective communication skills to inform women about the test.