Negative attitudes about aging of both older adults and health care providers can be barriers to self care in old age. The aims of this study were 1) to examine the extent to which older breast cancer survivors experience barriers to symptom management, and 2) to explore whether barriers influence quality of life. Three possible barriers to symptom management were examined: negative beliefs about managing symptoms, perceived negative attitudes of health care providers, and difficulties in communicating about symptoms. This study was a secondary analysis of pooled baseline data from 61 older (age > 64) women who participated in two pilot studies that tested a symptom management intervention for older breast cancer survivors. The most frequent barrier reported was difficulties in communicating about symptoms with health care providers. Each of the barriers affected psychosocial, but not physical, quality of life. Barriers to symptom management may lead to poorer self care of symptoms that can result in lower levels of psychosocial quality of life. Health care providers need to encourage older cancer survivors to report symptoms and worries related to their cancer diagnosis and should be cautious in expressing attitudes that could reinforce older adults' negative perceptions about aging. IntroductionAge is one of the most influential risk factors in breast cancer. 1, 2 Women aged 65 years and older comprise approximately 50% of the population newly diagnosed with breast cancer, and the 5-year survival rate after a breast cancer diagnosis in women aged over 50 is as high as 84%. 3 In spite of the high survival rate, experiencing and managing cancer in old age can be stressful because of age-related health declines, including multiple and often chronic symptoms, late effects of cancer treatments, and comorbidities. 4,5 Cancer often leaves numerous physical health sequelae that persist for decades despite successful treatments. 4 In addition, whether or not cancer survivors experience symptoms, they suffer from worries about a cancer recurrence and anxiety about an unknown future. 6 Accordingly, experiencing physical symptoms may aggravate psychological distress. Thus, effective management of multiple, often chronic, and comorbid symptoms is crucial in enhancing quality of life of older cancer survivors.However, older cancer survivors are faced with barriers to effective and active symptom management, some of which are rooted in negative beliefs about aging. Self-stereotypes about aging are negative attitudes about aging that older people apply to themselves that can influence their behaviors. 7 Ageist stereotypes on the part of health care providers may also influence older persons' behavior. These different sources of stereotypes about aging can influence older adults' beliefs about managing symptoms, their perceptions of negative attitudes about aging from their health care providers, and their communication about symptoms with HCPs. All three may function as barriers that prevent older adults from effectively mana...
Purpose/Objectives-To test the feasibility and acceptability of an individualized representational intervention to improve symptom management (IRIS) in older breast cancer survivors and test the short-term effects of an IRIS on symptom distress.Design-Two small randomized clinical trials and one pre-experimental study. Setting-Oncology clinic and community.Sample-41 women with breast cancer (aged 65 years and older) in pilot study 1, 20 in pilot study 2, and 21 in pilot study 3.Methods-In pilot study 1, women were randomized to the IRIS or usual care control. In pilot study 2, women were randomized to the IRIS or delayed IRIS (wait list) control. In pilot study 3, all women received the IRIS by telephone. Measures were collected at baseline, postintervention, and followup (up to four months).Main Research Variables-Feasibility, acceptability, symptom distress, symptom management behaviors, symptom management barriers, and quality of life.Findings-Across three pilot studies, 76% of eligible women participated, 95% completed the study, 88% reported the study was helpful, and 91% were satisfied with the study. Some measures of symptom distress decreased significantly after the IRIS, but quality of life was stable. Women in the IRIS group changed their symptom management behaviors more than controls. Conclusions-Preliminary evidence supports the need for and feasibility of an IRIS.Implications for Nursing-Nurses may help older breast cancer survivors manage their numerous chronic symptoms more effectively by assessing women's beliefs about their symptoms and their current symptom management strategies.More than a decade ago, the Oncology Nursing Society (ONS) recognized that oncology nurses will be caring for a growing number of older (aged 65 years or older) adults with cancer and that nursing care must meet the unique cancer-specific needs of this population (Boyle, 1992). The sentiment was revisited in 2007 in ONS's joint position with the Geriatric Oncology Consortium on cancer care for older adults. For older breast cancer survivors, the impact of a cancer diagnosis and cancer treatment combined with the physical and health changes commonly associated with aging result in unique survivorship issues (Deimling, Bowman, & Kahana, 2006;Deimling, Sterns, Bowman, & Kahana, 2005;Keating, Norredam, Landrum, Huskamp, & Meara, 2005;Yancik et al., 2001). One such issue is the experience of numerous, often chronic, symptoms that can be caused by cancer diagnosis and treatment, comorbid chronic health problems, and aging in general. These symptoms affect quality of life (QOL), including physical function, emotional well-being, and existential concerns. In clinical practice, healthcare providers are faced with trying to assist older breast cancer survivors in managing these symptoms. Yet, with a few exceptions (Sherwood et al., 2005), research has focused on testing symptom interventions that address a single symptom (Dodd et al., 2001). NIH Public AccessNursing interventions are needed to address the symptoms faced...
Practical strategies for providing home care services should be developed through a concrete assessment of the family dynamics and the needs of family caregivers. Health professionals should play a pivotal role in performing the assessment and in developing interventions to strengthen supportive family functioning.
Purpose/Objectives To describe relationships among perceived barriers to symptom management and quality of life and to test the mediating role of perceived communication difficulties on the relationships between other perceived barriers to symptom management and quality of life in older breast cancer survivors. Design Cross-sectional descriptive-correlational design using baseline data from a randomized controlled trial that tested the efficacy and durability of an Individualized Representational Intervention (IRIS) in reducing symptom distress and improving quality of life in older breast cancer survivors. Setting Participants were recruited from the community, an oncology clinic, and a state tumor registry. Sample 190 older breast cancer survivors (M age = 70.4) who were an average of 3.3 years after breast cancer diagnosis and who reported an average of 17.8 symptoms Methods Path analysis was conducted using Mplus. Main Research Variables Negative beliefs about symptom management (SMBQ), perceived negative attitudes from health care providers (CommA), and perceived communication difficulties (CommD), mental quality of life (MCS), physical quality of life (PCS), purpose in life (PIL), and positive relation with others (PR) Findings Significant direct effects of SMBQ and CommA on CommD were found after controlling for age, number of health problems, and number of symptoms. CommD was a significant mediator of the effects of CommA on quality of life, after controlling for the covariates. SMBQ had significant total effects on MCS, PIL, and PR after adjusting for the covariates, but was not mediated by CommD. Conclusions The mediating role of perceived communication difficulties with health care providers about symptoms suggests that patient-provider communication is an important factor in quality of life of older breast cancer survivors. Implications for Nursing Developing and testing nursing interventions focusing on enhancing both positive beliefs about symptom management and effective communication in old age is suggested.
Amid the global coronavirus disease 2019 (COVID-19) crisis, South Korea has been lauded for successfully preventing the spread of this infectious disease, which may be due to the aggressive implementation of preventive policies. This study was performed to evaluate the pattern of spread of COVID-19 in South Korea considering the potential impact of policy interventions on transmission rates. Methods: A SIR (susceptible-infected-removed) model with a breakpoint that allows a change in transmission rate at an unknown point was established. Estimated trajectories of COVID-19 from SIR models with and without a breakpoint were compared.Results: The proposed model with a break fitted the actual series of infection cases much better than the classic model. The estimated breakpoint was March 7, 2020 and the transmission rate dropped by 0.23 after the breakpoint. A counterfactual study based on our estimate indicated that the number of infected could have reached 2 500 000 compared to the peak of 8000 in the observed series. Conclusions: It is critical to consider a change in the transmission rate to evaluate the trajectory of spread of COVID-19 in South Korea. Our estimation and counterfactual experiments indicate that public health interventions may play a role in determining the pattern of spread of infectious diseases.
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