PurposeAdjuvant endocrine therapy (ET) can reduce the risk of recurrence among females with hormone receptor-positive breast cancer. Overall, initiation and adherence to ET are suboptimal, though reasons are not well described. The study’s objective was to better understand ET decision making, prescribing, and patient management from oncology providers’ perspectives.MethodsUsing purposive sampling, we recruited oncology providers who saw five or more breast cancer patients per week (n=20). We conducted 30–45-minute telephone interviews, using a semistructured guide to elicit perspectives on ET use. We used thematic content analysis to systematically identify categories of meaning and double-coded transcripts using Atlas.ti.ResultsProviders recommend ET to all eligible patients except those with contraindications or other risk factors. Providers base their ET prescribing decisions on the patient’s menopausal status, side effects, and comorbidities. ET is typically discussed multiple times: at the onset of breast cancer treatment and in more detail after other treatment completion. Providers felt that the associated recurrence risk reduction is the most compelling argument for patients during ET decision making. While providers rarely perceived noninitiation as a problem, nonadherence was prevalent, often due to unresolvable side effects.ConclusionFrom the clinicians’ perspectives, side effects from ET are the dominant factor in nonadherence. Efforts to improve adherence should focus on strategies to minimize side effects and ensure clinicians and patients are well informed regarding optimal side effect management. This finding has important implications for novel endocrine regimens that offer improved outcomes through longer duration or more intensive therapy.
artículos originales0 enseñar estrategias de afrontamiento a padres de niños con cáncer a través de un cortometrajeTeaching coping strategies to parents of children suffering from cancer using a short film Este trabajo describe la utilidad de un cortometraje para enseñar estrategias de afrontamiento positivas a los padres de hijos con cáncer.Para la realización del cortometraje se han utilizado los resultados de un trabajo de investigación sobre las estrategias de afrontamiento que utilizan los padres. Los resultados se extrajeron del análisis del discurso de los padres que participaron en un grupo de autoayuda durante ocho sesiones.El cortometraje ha sido evaluado por los psicólo-gos de todas las asociaciones de padres que forman parte de la Federación de padres de niños enfermos de cáncer. Asimismo, se ha experimentado en sesiones grupales realizadas en las sedes de ASPANION (Asociación de padres de niños oncológicos de la Comunidad Valenciana) de Valencia y Alicante.El 70% de los psicólogos considera que el cortometraje es un recurso válido para enseñar a los padres estrategias de afrontamiento y que es un instrumento dinamizador de las sesiones grupales, ya que se tratan temas que no habían surgido en el grupo anteriormente y se incrementa la comunicación y la participación de los padres.Palabras clave. Cortometraje. Familia. Oncología pediátrica. Estrategias de afrontamiento. Grupos de autoayuda. aBstractThis paper studies the usefulness of a short film in teaching strategies for parents of children with cancer to cope with the situation. The short film is based on an analysis of the transcripts from eight sessions of a self-help group.The short film has been evaluated by psychologists working for each of the parent groups belonging to the Federation of parents of children with cancer. Furthermore, the film has been exhibited in group sessions that took place in the Valencia and Alicante branches of ASPANION (Association of Parents with Oncologic Children in the Valencia Region).About 70% of the experts have declared that the film is a valuable resource for teaching useful strategies to parents. The film also improves the group sessions since it addresses a number of issues that had not been addressed before, and it stimulates the participation of, and communication between, parents during the session.
El objetivo de este artículo es conocer cómo los padres de niños enfermos de cáncer perciben sus relaciones con el personal sanitario, fundamentalmente con los médicos. Se ha utilizado una metodología de investigación cualitativa y grupal. La muestra la constituyen catorce madres/padres cuyos hijos hace más de dos años que han contraído la enfermedad.Los padres desean información inteligible, detallada y suficiente. La palabra cáncer tiene un gran estigma social, por lo que se intenta evitar cuando se da información a los padres y niños. La comunicación entre los médicos y padres puede tener momentos de tensión en el diagnóstico, recidivas, etc. Los padres confían en la profesionalidad de los médicos y desean que tengan, además de una buena competencia profesional, cualidades humanas. La elaboración de los informes por los médicos es la tarea más criticada por los padres.Palabras clave. Oncología. Relación médico-familia. Comunicación. Investigación cualitativa. aBstractWe want to learn how parents of children with cancer perceive their relationship with hospital staff, especially with doctors. We used group-based qualitative methodology. The sample is composed of 14 mothers/ fathers whose children contracted the disease more than two years previously.All parents want information that is both intelligible and detailed. The word cancer has a strong social stigma and is avoided when giving information to parents and to children. Communication between doctors and parents can lead to situations of tension during diagnosis and relapses. Parents trust the professionalism of doctors. Parents also want doctors to be competent and to have human qualities. The preparation of reports by physicians is the task most criticized by parents.
We also completed chart reviews on those patients where the tool was not completed or did not lead to a palliative referral. These reviews included direct interviews with admitting physicians. Results. n¼320 in 6 months. 106 completed trigger tools (33%). Of those, 34 PC consults requested and 72 not requested. 214 bypassed the trigger tool. Of those 214, 39% had a palliative consult requested. Chart reviews and interviews demonstrate time, knowledge deficiency, and physician EHR ''pop-up'' fatigue as contributing factors to not completing or not referring. Conclusions. Initial implementation of an admission trigger tool for patients with cancer did not lead to a significant increase in referrals to Palliative Care. Data collection continues after ongoing education regarding the use of trigger tools and need for timely palliative care involvement on appropriate patients along with improvement of implementation process.
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