One-third of women with self-discovered breast cancer are symptomatic for 3 months or more before seeking evaluation. Few studies examine women's accounts of this important time. Using narrative analysis in the style of Labov and Waletzky, breast cancer cases from a larger mixed-tumor sample of patients receiving chemotherapy were examined for the details of breast cancer symptom discovery and the events relevant to the timing of diagnosis and treatment. The majority (56.3%) of women in the sample sought evaluations within days, many proceeding to immediate diagnosis. Factors cited by women as influencing the delayed timing of initial provider evaluation were that they attributed the symptoms to a benign process, and they perceived gender role-related constraints. Many women in this younger-aged sample had false-negative mammographic examinations, and many reported receiving false reassurance from providers on initial consultation visits. Women who delayed evaluations sought them only as symptoms advanced.

Adult↗

PubMedDate not supplied

Patients' perspectives of fatigue while undergoing chemotherapy.

PURPOSE/OBJECTIVES: To explore the experience of fatigue from the perspective of patients undergoing chemotherapy. DESIGN: Qualitative research and secondary analysis of data from a larger study. SETTING: Participants were recruited from 18 sites, including large outpatient chemotherapy clinics and private medical oncologists' offices. SAMPLE: 127 adult patients who were beginning their first protocol of chemotherapy. METHODS: Data were collected through individual and open-ended interviews and a qualitative, thematic analysis of the participants' responses using grounded theory techniques. MAIN RESEARCH VARIABLE: The experience of fatigue as perceived by patients undergoing chemotherapy. FINDINGS: The analysis resulted in eight major thematic categories: (a) experiencing fatigue, (b) effects on well-being, (c) attribution of origin, (d) awareness and expectations, (e) emotional reactions, (f) activity, (g) the "biggest" concern, and (h) strategies and plans. CONCLUSIONS: This study demonstrates the variation, extent, duration, and temporality of fatigue among patients receiving chemotherapy and the dynamic, changing aspects of the experience. IMPLICATIONS FOR NURSING PRACTICE: Fatigue must be considered within the context of patients' daily lives and environments, disease processes, and treatment modalities. Nurses must listen carefully to patients' own descriptions of being tired. Further research examining patients' perspectives of and experiences related to fatigue is necessary to increase the theoretical understanding of fatigue and to improve therapeutic nursing interventions.

Activities of Daily Living↗

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Comparison of methods to determine the prevalence and nature of oral mucositis.

PURPOSE: Chemotherapy-induced oral mucositis may cause considerable patient morbidity. Its prevalence has been reported as ranging from 30% to 39%, although a prevalence as high as 75% has been reported with 5-fluorouracil. This variation may be a function, in part, of the methods of measurement used across different studies. The first purpose of this study was to determine the prevalence of oral mucositis in a sample of 127 patients receiving specific chemotherapy. The second purpose was to compare different instruments and techniques for assessing oral mucositis. DESCRIPTION OF STUDY: A longitudinal design was used to collect data at four monthly chemotherapy cycles during drug nadir. The methods of measuring oral mucositis included interview (conducted monthly x 4); Eiler's Oral Assessment Guide (monthly x 4); Chemotherapy Knowledge Questionnaire and Behavior Checklist (both at the fourth month); Self-Care Behavior Log (ongoing over 4 months); and medical record review (collected at 4 months). RESULTS: The mucositis prevalence in this one sample ranged from 30% to 69% depending on the method of measurement. The use of multiple instruments and techniques captured a clinical picture of oral mucositis far more detailed than published reports--a picture not revealed with any one instrument or technique. The chart record severely underdocumented the prevalence of mucositis compared to the interview. This discrepancy could reflect under-reporting by the patients, inadequate history taking at provider visits, or perhaps the documentation of only the more severe mucositis or mouth problems in the medical record. CLINICAL IMPLICATIONS: Clinicians and researchers must choose their method of measurement carefully in relation to the purpose of assessment. For subjective tolerance of symptoms, the interview technique may be most useful. To test interventions, the use of a quantitative rating instrument is desirable. Intervention studies using multiple measures may require a combination of subjective and objective measures.

Adult↗

PubMedDate not supplied

Helpseeking for self-discovered breast symptoms. Implications for early detection.

PURPOSE: Most breast cancer symptoms are discovered by women themselves, and at least one third of these women will be aware of their symptoms for 3 months or more before seeking an initial provider evaluation. The authors identify personal, social, and environmental influences on women's intention to seek an immediate provider evaluation (helpseek) versus to delay evaluation of a breast symptom that worried them. DESCRIPTION OF STUDY: Black women (N = 352) from the San Francisco Bay are women's organizations, community settings, and churches formed this convenience sample. Participants ranged across age, income, and educational levels. The survey contained 10 scales that measured health behavior variables, including new and existing scales augmented by items derived from prior interview and focus group investigations. RESULTS: Women of younger age and lower income were significantly less likely to intend to seek an evaluation for self-discovered breast symptoms. Single and partnered women were less likely to seek a provider evaluation than married or widowed women. Perceiving negative consequences of delaying, having previous habits of healthcare utilization, perceiving access to services, and feeling fearful were positively related to the intention to seek evaluation of breast symptoms. Holding fatalistic beliefs about getting breast cancer or dying and perceiving constraints to seeing a provider negatively influenced helpseeking intention. Racism in the healthcare delivery system was perceived, but was not a significant influence on helpseeking intention. A multiple linear regression model containing these variables explained 46% of the variance in helpseeking intention. CLINICAL IMPLICATIONS: This study shows that the intent to helpseek is not merely a matter of education and economics, but is dependent on a complex picture of personal, social, and economic factors. Gynecologic and primary care providers should consider this and the potential influences on helpseeking in the women for whom they provide cancer screening and early detection services. History taking should be expanded to assess women's ideas about the consequences of delaying evaluation of self-discovered breast symptoms, their sense of vulnerability to breast cancer, the constraints on cancer early detection they may be feeling related to role obligations, their economic or strategic limitations to accessing services, the pressures they may feel to hide a breast cancer symptom, or their own tendency to interpret the breast symptom as not threatening. Healthcare providers should not assume that helpseeking for breast symptoms is an automatic behavior for all women. Rather, providers should assess whether a women is the one in three who will delay the evaluation of a breast cancer symptom she discovers herself for months or years.

Adult↗