Breast Cancer Surgery Decision-Making and African-American Women

Abstract

Prior research has used focus group methodology to investigate cultural factors impacting the breast cancer experience of women of various ethnicities including African-Americans; however, this work has not specifically addressed treatment decision-making. This study identifies key issues faced by African-American women diagnosed with breast cancer regarding treatment decisions. We used an interpretive-descriptive study design based on qualitative data from three focus groups (n = 14) representing a population of African-American women in central Pennsylvania. Participants were asked to think back to when they were diagnosed with breast cancer and their visit with the breast surgeon. Questions were asked about the actual visit, treatment choices offered, sources of information, and whether the women felt prepared for the surgery and subsequent treatments. The prompts triggered memories and encouraged open discussion. The most important themes identified were fear across the breast cancer disease trajectory, a preference for visual information for understanding the diagnosis and surgical treatment, and support systems relying on family and friends, rather than the formal health-care system. Our results have implications for practice strategies and development of educational interventions that will help breast cancer patients better understand their diagnosis and treatment options, encourage their participation in treatment decision-making, and provide psychosocial support for those at high risk for emotional distress.

Systematic Review of Preoperative Patient Readiness

“…Addressing information needs or providing information was the common theme across 24 (89%) of the 28 studies 8,11,20,21,23‐38,40‐42 . We identified that two topics tied as the second‐leading issues; 8 (29%) of the 28 studies included a common focus of addressing pain concerns when providing preoperative care, 17,22,25,27,28,35,36,41 and 8 (29%) of the 28 studies addressed preoperative fear and anxiety 17,19,25,28,35,37‐39 . The next most frequent issues addressed were the need for support (8 [29%] of the 28 studies), 8,17,22,26,28,32,38,39 patient satisfaction with the surgical experience (8 [29%] of the 28 studies), 20,23,29,31,34,35,37,38 and the need to make a decision (4 [14%] of the 28 studies) 19,26,30,34 …”

“…Seventeen (61%) of the 28 studies that we reviewed highlighted the importance of health care team members providing adequate (eg, amount, content) and appropriate (eg, patient‐centered) information during the perioperative consenting process 8,11,17,20,22-26,28,33-36,38,40,41 . Perioperative nurses should work with other health care professionals (eg, surgeons) to allow patients sufficient time to understand the information and ask appropriate questions as they make decisions related to undergoing a surgical procedure.…”

“…Perioperative nurses should work with other health care professionals (eg, surgeons) to allow patients sufficient time to understand the information and ask appropriate questions as they make decisions related to undergoing a surgical procedure. Furthermore, the perioperative consenting process should include the preoperative patient’s support system (eg, family members); 17 and health care professionals should be responsive to the information needs of the patient, family members, or other support persons 8,18,21,38,40 …”

“…The 28 studies included 14 quantitative, 8,11,18,20,21,23,26,31‐35,40,42 12 qualitative, 17,19,22,24,25,27‐29,36,38,39,41 and two mixed‐methods studies 30,37 . We reviewed the 14 quantitative studies and determined that four studies were Level I, 11,31,33,42 two studies were Level II, 23,34 and eight studies were Level III 8,18,20,21,26,32,35,40 .…”

“…We rated the quality of 10 of the quantitative studies 11,18,20,21,23,31-34,42 as category B and the remaining quantitative studies as category A 8,26,35,40 . The strength of evidence of all 12 qualitative studies was Level III; 17,19,22,24,25,27-29,36,38,39,41 and we rated the quality of 11 (92%) of the 12 studies as category B, 17,19,24,25,27-29,36,38,39,41 which indicates researchers observed sampling adequacy and rigor; we rated the quality of the remaining study as category C 22 …”