Background Peer-to-peer support programs provide unique psychosocial and educational support for breast cancer patients. A Patient Survivor Advocacy (PSA) program was developed by the University of Wisconsin Breast Center (UWBC) to provide support for newly diagnosed patients from peers who had completed primary treatment. In this study, we evaluated patient, advocate and clinician experience with the PSA program. Materials and Methods A program matching volunteer peer advocates at least one year removed from primary treatment with newly diagnosed patients was developed. Peer advocates were recruited from the practices of UWBC clinicians, and received in-person training on six dimensions of peer advocacy. Trained advocates were then paired based on demographic and medical history with new patients referred to the program. Survey assessment tools were distributed to assess peer advocate and patient satisfaction, as well as clinician experience. Results Forty patients have been matched with 7 advocates, with contact largely by email (53%) or phone (36%). Patients and peer advocates reported satisfaction with the program. The majority of patients (92.9%) reported that the program was “helpful” and that they would recommend the PSA program to another woman with breast cancer. All peer advocates (100%) responded with a sense of achievement in their advocate roles. Clinicians noted challenges in referral to the program. Conclusion Peer advocates can provide key emotional and psychosocial support to newly diagnosed breast cancer patients. The peer advocate, patient, and clinician feedback collected in this study will inform the future development of this program at our and peer institutions.
Our objective was to describe when Hmong- and Spanish-speaking limited English proficient (LEP) patients perceive an interpreter was needed and how they perceive the decision to utilize an interpreter is made in a health care encounter. We interviewed a total of 20 LEP patients. We used a number of strategies to recruit LEP patients including posting language-appropriate flyers at clinics, sending letters to LEP patients and asking our participants to refer their family and friends to participate in our study. Tape-recorded interviews were transcribed, translated, and systematically coded using directed content analysis. Patients identified two factors that influenced LEP Hmong-and Spanish-speaking patients' perception of when interpreters were needed are as follows: (1) their self-identified level of English proficiency and (2) the anticipated complexity of the health care communication. They described three factors that they perceived influenced the decision to utilize interpreters: (1) their self-identified level of English proficiency, (2) access to interpreters; and (3) health system automation of interpreter use. The findings show that patients consider a wide variety of factors when determining if an interpreter is necessary and how the decision to utilize interpreters is made. Given that health care decision making is complex, healthcare systems need to do more to help educate LEP patients of the importance of utilizing interpreters in all healthcare encounters. Additionally, future research should to explore how patients conceptualize the need for and utilization of interpreters in order to provide LEP patients with linguistically appropriate care in ways that are sensitive to their perceptions and needs.
During the development of the autoimmune disease, insulin-dependent diabetes mellitus (IDDM) islet cell death is thought to be mediated in part by oxygen and nitrogen free radicals and interleukin 1beta (IL-1beta), secreted by activated macrophages. Free radicals disrupt the homeostasis of biological systems by damaging major constituent molecules such as lipids, proteins, and DNA. Islet cells are quite susceptible to oxidative damage due to low levels of antioxidant enzymes involved in free radical consumption. If IDDM is associated with an imbalance of oxidative stresses and antioxidant responses in islet cells, then it may be possible to ameliorate disease by supplementating antioxidant defenses. In this study, the antioxidants coenzyme Q10 and lipoic acid were able to block IL-1beta-mediated inhibition of glucose-stimulated insulin secretion from islet cells at 10(-12) M and 10(-9) M, respectively.
Peer-to-peer support programs provide unique psychosocial and educational support for breast cancer patients. With the support of funding from the South Central Wisconsin Affiliate of Susan G. Komen for the Cure, we developed a Patient-Survivor Advocacy (PSA) program to complement University of Wisconsin Breast Center (UWBC) patient navigator to facilitate peer-to-peer support between those who have completed primary breast cancer treatment and those newly diagnosed patients. We evaluated the feasibility and utility of this peer-to-peer support program for both patients and advocates. Methods: We recruited advocates from the pool of women previously treated for breast cancer at UWBC. PSAs completed 3 training sessions over a 5 month period, including a volunteer orientation and the After Breast Cancer Diagnosis (ABCD) program. Training topics included a patient survivor advocacy orientation, guidance for communication with patient matches, and documentation and reporting of patient contact to the UWBC patient navigator. Following training, PSAs were matched to patients based on age, type of breast cancer and other life factors identified as important by each referee. PSAs contacted matches via phone and documented communication frequency and content. PSAs and patients then completed surveys describing their experience and satisfaction with the PSA program. Survey questions were tailored to the program strengths, deficits, and areas for improvement. PSAs were also surveyed regarding curriculum and the training process. Results: Between 11/2012 and 4/2014, 14 PSAs were recruited and trained, and 40 patients were referred to the program. Half of patient referrals (20) were from UWBC physicians, while 18 were from UWBC nursing staff, in addition to 9 self-referrals (this includes overlapping referrals from multiple providers). Six decided not to participate, and one was transferred to hospice before being matched, while 8 patients were referred to the ABCD program due to lack of suitable UWBC PSA matches. Twenty six patients were successfully matched to active PSAs. The number of patients matched to each PSA ranged from 1 to 8; an average of 3 phone and 4 email contacts were made by each PSA-patient dyad. Communication topics included the effect of diagnosis and treatment on mood and mental health, physical health, daily life, and interpersonal relationships, as well as additional community resources for support. Patients and PSAs expressed positive impressions of the program: feeling supported by UWBC staff, experiencing a sense of accomplishment (PSAs) or direct benefit (patients). Responses suggested new topics for PSA training and cancer education, including surgical interventions, radiology, chemotherapy, integrative medicine, medical updates, and new topics in social support. Conclusions: The first year of the UWBC PSA program saw a successful peer-to-peer psychosocial support infrastructure for newly diagnosed breast cancer patients. PSA and patient survey responses provided useful feedback critical to development of the program. Future goals for this program include increased patient utilization, provision of additional education topics and materials during PSA training, and documentation of the impact of PSA program support on the UWBC nursing burden. Citation Format: Jennifer A Mirrielees, Lee G Wilke, Kayla R Breckheimer, Teresa A White, Deborah A DeNure, Michelle M Schroeder, Amye J Tevaarwerk. Breast cancer survivor advocacy at the University of Wisconsin Breast Center [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P5-15-16.
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