Miranda Chan

Trajectories of psychological distress among Chinese women diagnosed with breast cancer.

Background: The distinct trajectories of psychological distress over the first year of the diagnosis with breast cancer (BC) and its determinants have not been explored.

Participation and Satisfaction with Surgical Treatment Decision-Making in Breast Cancer Among Chinese Women

AbstractPurpose. To report Chinese womens preferred and perceived participation in breast cancer treatment decision making (TDM), describe influences on womens participation preference and participation congruence (PC) (correspondence between preferred and actual amount of participation in TDM), and explore subsequent satisfaction with TDM. Patients and methods. Of 172/211 eligible and available Chinese women recently undergoing breast cancer surgery at one of six Hong Kong government hospitals 154 (89.5%) were recruited. Within 12 days after surgery, women provided interview information on preferred and perceived TDM participation, satisfaction with TDM consultation, difficulties in TDM, and medical and demographic information. Results. Half (55%) reported a treatment choice: 33% wanted the choice to be their own, 59% wanted to share and 8% wanted to delegate the decision. Only age predicted participation preference with older women preferring a more passive role. Eighty percent of women participated as much as, 13% more than and 6% less than desired. Adjusted for age, women reporting PC had fewer difficulties in TDM (β = 0.21, p = 0.009) than women not reporting PC, while over-involved women had more doubts about their choice (β = −0.23, p = 0.005). PC was associated with being offered a treatment option (χ2 = 15.59, p < 0.001) and surgeons expressing a surgical preference (χ2 = 6.63, p = 0.036). Satisfaction was unrelated to PC. Conclusion. Most Chinese women want shared TDM and to know their surgeons treatment preference. Over-involved women are at greater risk of difficulties and doubts in TDM and under-involved women perceive a lack of time and information to make their decision.

Reducing Treatment Decision Conflict Difficulties in Breast Cancer Surgery: A Randomized Controlled Trial

PURPOSE Breast cancer (BC) decision aid (DA) randomized studies are limited to DA use in consultations among Western populations and for primary surgery. Their effectiveness beyond consultations, for reconstructive surgery and in other populations, has not been evaluated. We developed a DA administered after consultation for Chinese women deciding on BC surgery and, where relevant, immediate breast reconstruction, which was evaluated in this randomized controlled trial (RCT). PATIENTS AND METHODS Overall, 276 women considering BC surgery for early-stage BC were randomly assigned to receive a DA (take-home booklet) or the standard information booklet (control condition) after the initial consultation, wherein surgeons disclosed the diagnosis and discussed treatment options with patients. Using block random assignment by week, 138 women were assigned to the DA arm and 138 to the control arm. Participants completed interview-based questionnaires 1 week after consultation and then 1, 4, and 10 months after surgery. Primary outcome measures were decisional conflict, decision-making difficulties, BC knowledge 1 week after consultation, and decision regret 1 month after surgery. Secondary outcome measures were treatment decision, decision regret 4 and 10 months after surgery, and postsurgical anxiety and depression. RESULTS The DA group reported significantly lower decisional conflict scores 1 week after consultation (P = .016) compared with women in the control arm. Women receiving the DA had significantly lower decision regret scores 4 (P = .026) and 10 months (P = .014) after surgery and lower depression scores 10 months after surgery (P = .001). CONCLUSION This RCT demonstrated DAs may benefit Chinese patients in Hong Kong by reducing decisional conflict and subsequent regret and enhance clinical services for this population.

Help-seeking patterns in Chinese women with symptoms of breast disease: a qualitative study

BACKGROUND Prompt utilization of health services on detecting breast symptoms can improve breast cancer (BC) survival. Little is known about Chinese womens help-seeking behaviour. Our aim was to determine patterns of self-referral among Hong Kong Chinese women with self-detected breast symptoms. METHODS We recruited 37 women awaiting their first consultation at public hospitals for breast symptoms. Interviews were transcribed and analysed based on the grounded theory approaches. RESULTS A two-stage help-seeking model provided the best interpretation of the data. Symptom recognition was triggered by symptom interpretation, symptom progression and social messages. Painful lumps were seen as symptomatic, but atypical symptoms were often dismissed as benign as they responded to dietary change. Symptom intensification and discussions with someone who had faced BC prompted consultation. Service utilization involved fear of consequences, confirmation need, symptom distress, lay referral, media prompts and opportunistic presentation. Fearing cancer as incurable delayed consultation. Utilization barriers included cost, uncertainty about referral pathways, competing priorities and embarrassment. CONCLUSIONS Atypical and painless presentation was more common among women delaying presentation. Barriers included cost, access, time and embarrassment. Education should emphasize atypical symptoms, the high-cure rate and the need for early presentation. Reduced cost and improved access to clinics would enhance early consultation.

The Chinese medical interview satisfaction scale-revised (C-MISS-R): Development and validation

Background: The Medical Interview Satisfaction Scale (MISS) measures patient consultation satisfaction. We validated a translated short-form of the original MISS on Hong Kong Chinese women with breast cancer. Methods: The four highest scoring MISS Cognitive and Affective sub-scales items were administered in Chinese (C-MISS) to 224 female out patients. Phrasing revisions (C-MISS-R) were tested on 82 women. Random split tested factor structure stability. Convergent, divergent and criterion validation against other instruments was performed on 405 women. Results: Two-factors accounted for 61.7% of variance but factor loadings differed from the original. Phrasing revision increased Affective sub-scale item–item correlations exceeding 0.3–64%. Two factors matching those of the original MISS, accounting for 65.2% of variance, explained 36.6 (Cognitive) and 28.8% (Affective) of variance, respectively. Alpha was 0.84, 0.74 and 0.83 for the Cognitive and Affective sub-scales and total respectively. Correlations of difficulties with treatment decision making (r = −0.298), Self-efficacy (r = 0.194), optimism (r = 0.33), psychological morbidity (r=−209), marital status, education and age indicated acceptable validity. Test–retest reliability was 0.410. Discussion: The Chinese MISS-Revised (C-MISS-R) has suitable factor structure and psychometric properties for use in consultation studies among Chinese female populations. Further validation is needed for males.

Waiting to see the doctor: understanding appraisal and utilization components of consultation delay for new breast symptoms in Chinese women

Delayed consultation for potential cancer symptoms influences treatment outcomes and remains problematic. Delay components (Appraisal versus Utilization) and respective associations are poorly understood.

Social adjustment among Chinese women following breast cancer surgery

Background: How breast cancer surgery affects social adjustment among Chinese women is unknown, as are factors predicting such adjustment.

Communicative characteristics of interactions between surgeons and Chinese women with breast cancer in oncology consultation: a conversation analysis

While previous studies have analysed features of interaction in cancer consultations using observational coding frames, relatively little attention is being given to how actual interactions are sequentially organized and achieved by participants in the course of talk‐in‐interaction. Research into the interactional practices in consultations, which involves Chinese patients, is largely absent.

The effect of decision aids on Treatment Decision Making for Breast Cancer Surgery: a randomized controlled trial

Nadine Köhle 1, Constance Drossaert2, Cornelia van Uden-Kraan3, Irma Verdonck -de Leeuw4, Ernst Bohlmeijer5 1University of Twente, Enschede, Overijssel, The Netherlands, 2University of Twente, Enschede, Overijssel, The Netherlands, 3VU University, Amsterdam, Noord-Holland, The Netherlands, 4VU University, Amsterdam, Noord-Holland, The Netherlands, 5University of Twente, Enschede, Overijssel, The NetherlandsFrom Vision to Action - Innovation and Implementation of an Integrated Cancer Rehabilitation Within Clinical Practice