BACKGROUND Previous research indicates that younger women (i.e., ≤ 50) with breast carcinoma experience greater emotional distress than older women (i.e., > 50) and that coping style is significantly related to the psychosocial adjustment of women with this disease. The purpose of this study was to evaluate through a randomized controlled trial the effectiveness of a problem‐solving training intervention designed to empower women with breast carcinoma to cope with a range of difficulties when diagnosed in mid‐life. METHODS The study population consisted of women aged 50 years or younger who had no prior history of breast carcinoma, were diagnosed with Stage I‐IIIA tumors, and for whom a first course of chemotherapy had been initiated recently. The intervention consisted of two in‐person and four telephone sessions with an oncology nurse who provided problem‐solving skills training and informational materials to the women over a 12‐week period. All subjects were assessed for physical and psychosocial adjustment through telephone and mailed surveys at baseline, at 4 –months, and at 8 months. RESULTS Of 183 eligible women, 164 participated (a 90% participation rate), 149 of whom completed the study (a 91% completion rate). The subjects had significantly lower unmet needs and better mental health at the 4‐month assessment. The intervention significantly decreased the number and severity of difficulties experienced by women with average or good problem‐solving skills at 8 months, but was not effective in alleviating or resolving the problems encountered by women with poor problem‐solving skills, relative to the control group. CONCLUSIONS We conclude that this problem‐solving therapy‐based home care training intervention is an effective method of helping the majority of women with breast carcinoma to reduce the stresses associated with the diagnosis and treatment of cancer in mid‐life. Cancer 2002;94:3089–100. © 2002 American Cancer Society. DOI 10.1002/cncr.10586

The relationship between the use of complementary therapy (CT) and satisfaction with medical treatment decision making and with the treating oncologist was evaluated in a sample of 166 women who were undergoing an initial course of chemotherapy for early-stage breast cancer. At the beginning of chemotherapy, 39% indicated already trying CT and an additional 13% reported planning to try CT. These women mentioned a variety of vitamin, nutritional, herbal, physical, mental, and spiritual approaches. Four months later, when most patients had completed chemotherapy, more than half (53%) reported using CT, with another 8% planning to try it. Regression analysis controlling for psychosocial and medical variables revealed that women who were younger and less satisfied with their treatment decisionmaking experience were significantly more likely to use CT. When predicting use of CT at the conclusion of treatment, baseline utilization was the greatest predictor, but dissatisfaction with the oncologist was also a significant predictor. These findings suggest that patients who are dissatisfied with their medical care may be more likely to use CT during treatment. Further research is needed to elucidate the relationship between satisfaction with medical decision making and the patient-physician relationship to CT use among cancer patients. The findings also highlight the importance of good patient-physician communication about CT use throughout the cancer treatment experience. Keywords: breast cancer; complementary therapy; patientphysician communication; satisfaction with medical decision makingThe use of complementary and alternative therapies by cancer patients has steadily increased over the past decade, 1-6 particularly among women with breast cancer.7-10 While findings regarding the characteristics of women who use complementary therapy (CT) are relatively consistent across studies, not much is known about the stimuli that influence the decision to use CT during conventional cancer treatment. For example, while there is some evidence that patientphysician communication about breast cancer treatment decisions may be frustrating for women, 11,12 it is not yet clear how patient satisfaction with this exchange may be related to CT use. This article presents data on CT utilization among breast cancer patients undergoing chemotherapy with an emphasis on the relationship between CT use and patients' satisfaction with medical treatment decision making as well as with their medical oncologist. Prevalence and Correlates of CT Use Among Women With Breast CancerEstimates suggest that most adult cancer patients use some form of CT.13-16 CT use appears particularly prevalent among women with breast cancer relative to other illness populations. 3,17,18 In one study, breast cancer patients were twice as likely to report using CT than were prostate cancer or gastrointestinal cancer patients. 19 The lack of a concise definition of CT has hindered studies from providing reliable use estimates and has made comparisons across studies diffi...

In the 1990s, acute care hospitals in the United States encountered an unstable operating environment created by a series of transformations in the health care delivery system and long-term-care market. Confronted with an array of economic pressures and demographic changes, hospitals were motivated to engage in long-term-care diversification, such as establishing a long-term-care unit or providing home health services, as a means of entering new markets and ensuring financial stability. This article examines the organizational, market, and community factors associated with this strategic activity among a national sample of urban and rural hospitals.

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