Kim Wagler Ziner

Comparison of younger and older breast cancer survivors and age‐matched controls on specific and overall quality of life domains

Younger survivors (YS) of breast cancer often report more survivorship symptoms such as fatigue, depression, sexual difficulty, and cognitive problems than older survivors (OS). This study sought to determine the effect of breast cancer and age at diagnosis on quality of life (QoL) by comparing 3 groups: 1) YS diagnosed at age 45 years or before, 2) OS diagnosed between 55 and 70, and 3) for the YSs, age‐matched controls (AC) of women not diagnosed with breast cancer.

Health-related quality of life of African American breast cancer survivors compared with healthy African American women

Background: The diagnosis and treatment of breast cancer can result in an array of late cancer-specific side effects and changes in general well-being. Research has focused on white samples, limiting our understanding of the unique health-related quality of life outcomes of African American breast cancer survivors (BCSs). Even when African American BCSs have been targeted, research is limited by small samples and failure to include comparisons of peers without a history of breast cancer. Objective: The purpose of this study was to compare health-related quality of life of African American female BCSs with that of African American women with no history of breast cancer (control group). Methods: A total of 140 women (62 BCSs and 78 controls), 18 years or older and 2 to 10 years postdiagnosis, were recruited from a breast cancer clinic and cancer support groups. Participants provided informed consent and completed a 1-time survey based on the proximal-distal health-related quality of life model of Brenner et al (1995). Results: After adjusting for age, education, income, and body mass index, results show that African American BCSs experienced more fatigue (P = .001), worse hot flashes (P < .001), and worse sleep quality (P < .001) but more social support from their partner (P = .028) and more positive change (P = .001) compared with African American female controls. Conclusions: Our results suggest that African American female BCSs may experience unique health-related outcomes that transcend age, education, socioeconomic status, and body mass index. Implications for Practice: Findings suggest the importance of understanding the survivorship experience for particular racial and ethnic subgroups to proactively assess difficulties and plan interventions.

An Intervention to Improve Communication Between Breast Cancer Survivors and Their Physicians

Breast cancer survivors often use clues to convey their concerns to their oncologists. The authors conducted a randomized trial of a communication coaching intervention in which 22 female breast cancer survivors were randomized to the coaching and 22 to treatment as usual. They hypothesized that the intervention would increase breast cancer self-efficacy, improve mood, and reduce fears of recurrence. Through a series of ANCOVAs they found that the intervention led to increases in self-efficacy. Changes in self-efficacy predicted changes in anxiety, depression, and womanhood fears. This coaching intervention shows promise but requires additional studies to establish is efficacy and effectiveness.

Development and psychometric testing of a breast cancer survivor self-efficacy scale.

PURPOSE/OBJECTIVES To describe the development of a self-efficacy instrument that measures perceived ability to manage symptoms and quality-of-life problems resulting from the diagnosis and treatment of breast cancer. DESIGN Items were developed and content validity assessed. A 14-item scale was psychometrically evaluated using internal consistency reliability and several types of construct validity. SAMPLE 1,127 female breast cancer survivors (BCSs). METHODS Written consents were mailed to the research office. Data were collected via mail and telephone. MAIN RESEARCH VARIABLES Demographics, symptom bother, communication with healthcare provider, attention function, fear of recurrence, depression, marital satisfaction, fatigue, sexual functioning, trait and state anxiety, and overall well-being. FINDINGS Data demonstrated that the breast cancer self-efficacy scale (BCSES) was reliable, with an alpha coefficient of 0.89, inter-item correlations ranging from 0.3-0.6, and item-total correlation coefficients ranging from 0.5-0.73. Three of 14 items were deleted because of redundancy as identified through high (> 0.7) inter-item correlations. Factor analysis revealed that the scale was unidimensional. Predictive validity was supported through testing associations between self-efficacy and theoretically supported quality-of-life variables, including physical, psychological, and social dimensions, as well as overall well-being. CONCLUSIONS The BCSES demonstrated high internal consistency reliability, unidimensionality, and excellent content and construct validity. This scale should be integrated into interventions that target self-efficacy for managing symptoms in BCSs. IMPLICATIONS FOR NURSING Nurses working with BCSs may use this tool to assess areas in which survivors might need to build confidence to adequately cope with their specific survivorship concerns. KNOWLEDGE TRANSLATION The use of the BCSES can inform nurse researchers about the impact of an intervention on self-efficacy in the context of breast cancer survivorship, improving the ability to deliver effective interventions. The scale is brief and easy to administer. Results of this study demonstrate clear psychometric reliability and validity, suggesting that the BCSES should be put to use immediately in interventions targeting the quality of life of BCSs.

Death Worries and Quality of Life in Younger Breast Cancer Survivors

Cancer is the leading cause of death by disease in women 20 to 39 years of age. Surprisingly, a significant number of women develop breast cancer at age 45 or younger. Women treated for breast cancer experience many physical and psychological problems during survivorship—in particular worry about death and fear of breast cancer recurrence. This worry about death may affect physical, psychological, and general quality of life (QOL) domains. The purpose of this study is to describe how worry of death is related to physical outcomes, psychological outcomes, self-efficacy in dealing with breast cancer, and overall QOL as measured by the Impact of Events Scale. A theoretical model for predicting QOL developed by Ferrell and colleagues has directed the analysis. Theoretically, antecedent variables including personal characteristics and mediating variables including selfefficacy and worry about death predict physical, psychological, and general QOL outcomes. For this study, a cross-sectional, secondary analysis from an ongoing QOL study is conducted using a subset of 195 young women diagnosed with breast cancer who are between the ages of 22 and 45. Descriptive statistics, correlations, and multiple regressions are used for the analyses. Results indicate that self-efficacy is inversely related to death worries (p = .001) and directly related to age (p = .015). A linear regression finds that the combination of current age, self-efficacy, death worries, state anxiety, subjective sleep quality, and symptom bother significantly predicts MNRS Doctoral Student Award Abstract

A Process to Manage Recruitment to Multiple Competing Studies

Although strategies for decreasing barriers to research participation have been previously published, specific strategies for managing recruitment in the context of multiple, competing studies have not been addressed. This article addresses the development and implementation of a coordinated recruitment core aimed at managing recruitment to multiple studies competing for patients within a breast cancer clinic. The discussion centers around the process used to define the problem and need for change, the proposed change, steps in implementing the change, strategies to facilitate implementation of the change, and initial evaluation, including expected and unexpected benefits. Also included is a discussion of future directions.