Perceived importance of evidence-based psychosocial clinical guidelines for Hong Kong Chinese women with breast cancer: opinions of patients and health care providers.

AIM: The aim of this study was to assess Chinese breast cancer patients' and health care providers' (HCPs) perceptions of psychosocial clinical guidelines developed by the Australian National Health and Medical Research Council's National Breast Cancer Centre. MATERIALS AND METHODS: A convenience sample of Hong Kong Chinese women diagnosed with breast cancer was recruited. In addition, all surgeons and clinical/medical oncologists registered with the Hong Kong Medical Council were invited to complete a mailed survey. Both women and HCPs were asked to rate the importance of the 55 psychosocial clinical guideline items. HCPs also rated the feasibility of implementing each item in their practice. Overall, 344 of 362 (95%) women completed the face-to-face interview. Of 490 eligible HCPs, 75 (15%) completed the mailed survey. RESULTS: At least 50% of the women rated 16 of the 55 psychosocial issues as an essential part of psychosocial care in clinical practice. The top ten ranked items rated essential by patients addressed disease and treatment information provision and question opportunity. HCPs also placed high priority on the scope and opportunities for information giving. Emotional care was intermediately valued. Practical issues and providing social support were rated by both patients and HCPs as the least important aspect of psychosocial care in clinical practice. Fewer than half of the HCPs rated any psychosocial item as feasible to implement in their practice. CONCLUSIONS: Chinese women value information provision and question opportunities, highlighting the need of HCPs to address these issues. Interventions that facilitate HCP's provision of psychosocial support in breast cancer should be set as a high priority.

Avian influenza risk perception and live poultry purchase in Guangzhou, China, 2006.

Human H5N1 highly pathogenic avian influenza (HPAI) infection is associated with intimate exposure to live poultry. Perceptions of risk can modify behaviors, influencing actual exposure. However, greater hazard is not necessarily followed by perception of greater risk and more precautionary behavior because self-serving cognitive biases modulate precautionary and hazardous behaviors. We examined risk perception associated with avian influenza. A total of 1,550 face-to-face within-household interviews and 1,760 telephone interviews were derived to study avian influenza risk perception and live poultry use in Guangzhou and Hong Kong, respectively. Chi-square and Mann-Whitney tests assessed bivariate associations and risk distributions, respectively, and fully adjusted multivariate logistic models determined independent risk associations. Relative to Hong Kong, perceived "generalized" risk from buying live poultry (GZ, 58%, 95% confidence interval 55-60% vs. HK, 41%, 39-43%; chi(2)= 86.95, df = 1, p < 0.001) and perceived self/family risk from buying (z =-2.092, p = 0.036) were higher in Guangzhou. Higher perceived "generalized" risk was associated with not buying live poultry (OR = 0.65, 0.49-0.85), consistent with the pattern seen in Hong Kong, while perceived higher self/family risk was associated with buying ("likely/very likely/certain" OR = 1.74, 1.18-2.59); no such association was seen in Hong Kong. Multivariate adjustment indicated older age was associated with buying live poultry in Guangzhou (OR = 2.91, 1.36-6.25). Guangzhou respondents perceived greater risk relative to Hong Kong. Buying live poultry was associated with perceptions of less "generalized" risk but more self/family risk. Higher generalized risk was associated with fewer live poultry purchases, suggesting generalized risk may be a useful indicator of precautionary HPAI risk behavior.

Live poultry exposures, Hong Kong and Hanoi, 2006.

Since 1997, the largest epidemic of highly pathogenic avian influenza (H5N1) ever recorded has caused 172 human and several billion bird deaths. Recently administered questionnaires determined that live poultry exposures have declined by approximately 63% in Hong Kong since 2004 and that, in Vietnam, domestic backyard exposures to poultry are likely more important than retail exposures.

The Chinese Medical Interview Satisfaction Scale-revised (C-MISS-R): development and validation.

BACKGROUND: The Medical Interview Satisfaction Scale (MISS) measures patient consultation satisfaction. We validated a translated short-form of the original MISS on Hong Kong Chinese women with breast cancer. METHODS: The four highest scoring MISS Cognitive and Affective sub-scales items were administered in Chinese (C-MISS) to 224 female out patients. Phrasing revisions (C-MISS-R) were tested on 82 women. Random split tested factor structure stability. Convergent, divergent and criterion validation against other instruments was performed on 405 women. RESULTS: Two-factors accounted for 61.7% of variance but factor loadings differed from the original. Phrasing revision increased Affective sub-scale item-item correlations exceeding 0.3-64%. Two factors matching those of the original MISS, accounting for 65.2% of variance, explained 36.6% (Cognitive) and 28.8% (Affective) of variance, respectively. Alpha was 0.84,0.74 and 0.83 for the Cognitive and Affective sub-scales and total respectively. Correlations of difficulties with treatment decision making (r = -0.298), Self-efficacy (r = 0.194), optimism (r = 0.33), psychological morbidity (r = -209), marital status, education and age indicated acceptable validity. Test-retest reliability was 0.410. DISCUSSION: The Chinese MISS-Revised (C-MISS-R) has suitable factor structure and psychometric properties for use in consultation studies among Chinese female populations. Further validation is needed for males.

Avian influenza risk perception, Hong Kong.

A telephone survey of 986 Hong Kong households determined exposure and risk perception of avian influenza from live chicken sales. Householders bought 38,370,000 live chickens; 11% touched them when buying, generating 4,220,000 exposures annually; 36% (95% confidence interval [CI] 33%-39%) perceived this as risky, 9% (7%-11%) estimated >50% likelihood of resultant sickness, whereas 46% (43%-49%) said friends worried about such sickness. Recent China travel (adjusted odds ratio 0.35; CI 0.13-0.91), traditional beliefs (1.20, 1.06-1.13), willingness to change (0.29, 0.11-0.81) and believing cooking protects against avian influenza (8.66, 1.61-46.68) predicted buying. Birth in China (2.79, 1.43-5.44) or overseas (4.23, 1.43-12.53) and unemployment (3.87, 1.24-12.07) predicted touching. Age, avian influenza contagion worries, husbandry threat, avian influenza threat, and avian influenza anxiety predicted perceived sickness risk. High population exposures to live chickens and low perceived risk are potentially important health threats in avian influenza.

Predicting psychological morbidity in Chinese women after surgery for breast carcinoma.

BACKGROUND: Between 30% and 70% of western women experience psychological morbidity after undergoing surgery for breast carcinoma; however, the rates and risk factors among Chinese women are unknown. Identifying at-risk women enables preventive intervention. METHODS: Among 430 Chinese women who were approached within 1 week after undergoing surgery for early-stage breast carcinoma (baseline), 405 women (94%) completed measures of self-efficacy and psychological morbidity (the Chinese Health Questionnaire 12-item instrument [CHQ12]) and completed retrospective measures of treatment decision-making (TDM) difficulties, satisfaction with TDM involvement, and satisfaction with consultation and treatment outcome expectations. One-month postsurgery follow-up (follow-up), CHQ12 scores for 367 of 405 women (91%) were adjusted for concurrent physical symptom distress and trait optimism (the revised Chinese Life Orientation Test) and baseline predictors using stepwise multivariate regression. RESULTS: At baseline 28% of women evidenced mild psychological morbidity, and 42% of women evidenced moderate-to-severe psychological morbidity: At follow-up, the respective rates were 32% and 36%. Preferred TDM involvement was associated with lower psychological morbidity (F = 6.702; P < 0.001). Baseline CHQ12 scores were predicted by outcome expectancies and TDM difficulties (adjusted regression coefficient [R(2)] = 0.192). Baseline CHQ12 scores and follow-up chemotherapy, in turn, predicted physical symptom distress at follow-up. After adjustment, high physical symptom distress, baseline psychological morbidity, low optimism, and no chemotherapy independently predicted follow-up CHQ12 scores (adjusted R(2) = 0.585). CONCLUSIONS: Psychological morbidity was linked to women's TDM difficulties, their inability to anticipate treatment effects accurately, and physical symptom distress, possibly exacerbated by symptom misattribution. Optimizing TDM support and helping women accurately determine outcomes in terms of symptom experience and meaning and physical appearance may help to reduce psychological morbidity. Women who have TDM difficulties should be considered to be at high risk for psychological distress.

Surgeon's recommendation, perceived operative efficacy and age dictate treatment choice by Chinese women facing breast cancer surgery.

PURPOSE: to identify factors influencing Chinese women's choices between breast-conserving therapy (BCT), mastectomy (MRM) or MRM followed by breast reconstruction (MRM+R). METHODS: of 405/443 Hong Kong Chinese women receiving surgery for early breast cancer who were interviewed one week post-surgery about their pre-surgical consultation, available treatment alternatives, whether their surgeons had indicated a surgical preference, perceived efficacy of the surgical options and considerations influencing their treatment decisions (TDM), 198 (49%) reported they were offered a choice of surgery. RESULTS: among women offered a choice of surgery, BCT was chosen by 34/43 (79%) of women whose surgeons recommended BCT but by only 34/96 (37%) of women whose surgeons expressed no treatment recommendation. Multivariate adjustment showed women choosing MRM were influenced more by avoiding both cancer recurrence (p = 0.003) and further treatment (p = 0.009) when choosing surgical option than women choosing BCT. In contrast, women choosing MRM+R and BCT, placed more emphasis on appearance (p < 0.001) and body image (p < 0.001) concerns as influencing treatment choice than did women who chose MRM. CONCLUSION: survival concerns rather than physical appearance, age and lack of recommendation push Chinese women to choose MRM as BCT is, incorrectly often seen as less efficacious. Recommending BCT increases BCT choice.

Participation and satisfaction with surgical treatment decision-making in breast cancer among Chinese women.

PURPOSE: To report Chinese women's preferred and perceived participation in breast cancer treatment decision making (TDM), describe influences on women's participation preference and participation congruence (PC) (correspondence between preferred and actual amount of participation in TDM), and explore subsequent satisfaction with TDM. PATIENTS AND METHODS: Of 172/211 eligible and available Chinese women recently undergoing breast cancer surgery at one of six Hong Kong government hospitals 154 (89.5%) were recruited. Within 12 days after surgery, women provided interview information on preferred and perceived TDM participation, satisfaction with TDM consultation, difficulties in TDM, and medical and demographic information. RESULTS: Half (55%) reported a treatment choice: 33% wanted the choice to be their own, 59% wanted to share and 8% wanted to delegate the decision. Only age predicted participation preference with older women preferring a more passive role. Eighty percent of women participated as much as, 13% more than and 6% less than desired. Adjusted for age, women reporting PC had fewer difficulties in TDM (beta = 0.21, p = 0.009) than women not reporting PC, while over-involved women had more doubts about their choice (beta = -0.23, p = 0.005). PC was associated with being offered a treatment option (chi2 = 15.59, p < 0.001) and surgeons expressing a surgical preference (chi2 = 6.63, p = 0.036). Satisfaction was unrelated to PC. CONCLUSION: Most Chinese women want shared TDM and to know their surgeon's treatment preference. Over-involved women are at greater risk of difficulties and doubts in TDM and under-involved women perceive a lack of time and information to make their decision.