Miyako Takahashi

Disclosure preferences regarding cancer diagnosis and prognosis: to tell or not to tell?

Telling people that they have cancer has a great impact on their lives, so many doctors are concerned about how they should inform patients about a cancer diagnosis and its prognosis. We conducted a general population survey in Japan to investigate people’s preferences on receiving this information. There were no significant differences in respondents’ preferences according to the seriousness of the cancer. Full disclosure of the diagnosis was preferred by 86.1% of the respondents, while 2.7% wanted non-disclosure. As for the initial provision of information, the majority preferred partial disclosure concerning the prospects of complete recovery (64.5%) and the expected length of survival (64.1%). Those who responded negatively to the statement, “If I am close to the end of my life, I want to be informed of the fact so I can choose my own way of life”, were more likely to want non-disclosure on diagnosis. The results suggest that, at the first opportunity of providing information, a disclosure policy of giving patients full details of their diagnosis and some information on prognosis can satisfy the preferences of most patients. Contrary to popular belief, the seriousness of the cancer and people’s demographic characteristics displayed little impact in this study.

Impact of communicative and critical health literacy on understanding of diabetes care and self-efficacy in diabetes management: a cross-sectional study of primary care in Japan

BackgroundThe role of a patient’s functional health literacy (HL) has received much attention in the context of diabetes education, but researchers have not fully investigated the roles of communicative and critical HL, especially in primary care. Communicative HL is the skill to extract health information and derive meaning from different forms of communication, and to apply this information to changing circumstances. Critical HL allows the patient to critically analyze information and to use this information to achieve greater control over life events and situations. We examined how HL, particularly communicative and critical HL, is related to the patient’s understanding of diabetes care and self-efficacy for diabetes management in primary care settings. We also examined the impact of patient–physician communication factors on these outcomes, taking HL into account.MethodsWe conducted a cross-sectional observational study of 326 patients with type 2 diabetes who were seen at 17 primary care clinics in Japan. The patients completed a self-administered questionnaire that assessed their HL (functional, communicative, and critical), understanding of diabetes care, and self-efficacy for diabetes management. We also examined the perceived clarity of the physician’s explanation to assess patient–physician communication. Multivariate regression analyses were performed to determine whether HL and patient–physician communication were associated with understanding of diabetes care and self-efficacy.ResultsA total of 269 questionnaires were analyzed. Communicative and critical HL were positively associated with understanding of diabetes care (β = 0.558, 0.451, p < 0.001) and self-efficacy (β = 0.365, 0.369, p < 0.001), respectively. The clarity of physician’s explanation was associated with understanding of diabetes care (β = 0.272, p < 0.001) and self-efficacy (β = 0.255, p < 0.001). In multivariate regression models, HL and perceived clarity of the physician’s explanation were independently associated with understanding of diabetes care and self-efficacy.ConclusionsCommunicative and critical HL and clear patient–physician communication were independently associated with the patient’s understanding of diabetes care and self-efficacy. The potential impact of communicative and critical HL should be considered in communications with, and the education of, patients with diabetes in primary care settings.

The Female Sexual Function Index (FSFI): Development of a Japanese Version

INTRODUCTION A valid and reliable self-administered scale to measure multidimensional aspects of female sexual function is needed in Japan, as sexual dysfunction is quite common in Japanese women. AIM The aim of this paper is to develop a Japanese translation of the Female Sexual Function Index (FSFI-J), 3-month version, and to measure its psychometric reliability and validity. METHODS Following a language validation process and pilot tests, we modified the scale by adding some instructions and answer options. A cross-sectional survey to examine psychometric reliability and validity of FSFI-J was conducted with 126 healthy Japanese women in partnered relationships. Reliability studies on test-retest and on internal consistency were conducted using the intraclass correlation coefficient (ICC) and Cronbachs α coefficient, respectively. A validity study was conducted on aspects of face, construct, concurrent, and discriminant validity. MAIN OUTCOME MEASURES The main outcome is the psychometric reliability and validity of FSFI-J. RESULTS FSFI-J showed high test-retest reliability (ICC > 0.78) and high internal consistency (Cronbachs α > 0.84). In terms of face validity, FSFI-J was found to be understandable and can adequately measure various aspects of female sexual function. Regarding construct validity, exploratory factor analysis of FSFI-J supported a five-factor solution, consisting of desire/arousal, lubrication, orgasm, satisfaction, and pain. This domain structure was identical to that of the original FSFI. Regarding concurrent validity, FSFI-J total score and domain scores showed significant correlations (Pearsons r = -0.613 for total score) with the sexual function domain of the perimenopausal subjective symptom inventory and overall sexual satisfaction as measured by a visual analog scale (Pearsons r = 0.387). For discriminant validity, the regular menstruation group showed significantly higher FSFI-J scores than the menopause group in the total score and all subdomain scores except sexual satisfaction. CONCLUSIONS The FSFI-J is a valid and reliable instrument to measure multidimensional aspects of sexual function in healthy Japanese women who are in partnered relationships.

Factors associated with intentions to adhere to colorectal cancer screening follow-up exams.

BackgroundTo increase adherence rate to recommendations for follow-up after abnormal colorectal cancer (CRC) screening results, factors that inhibit and facilitate follow-up must be identified. The purpose of this study was to identify the factors associated with intention to adhere to CRC screening follow-up exams.MethodsDuring a 4-week period in October 2003, this survey was conducted with 426 subjects participating in a community-based CRC screening program in Nagano, Japan. Study measures included intention to adhere to recommendation for clinical follow-up in the event of an abnormal fecal occult blood test (FOBT) result, perceived susceptibility and severity of CRC, perceived benefits and barriers related to undergoing follow-up examination, social support, knowledge of CRC risk factors, health status, previous CRC screening, personality and social demographic characteristics. Univariate and multivariate logistic regression analyses on intention to adhere to recommendations for follow-up were performed.ResultsAmong the 288 individuals analyzed, approximately 74.7% indicated that they would definitely adhere to recommendations for follow-up. After controlling for age, gender, marital status, education, economic status, trait anxiety, bowel symptoms, family history of CRC, and previous screening FOBT, analyses revealed that lower levels of perceived barriers, higher levers of perceived benefits and knowledge of CRC risk factors were significantly associated with high intention respectively.ConclusionThe results of this study suggest that future interventions should focus on reducing modifiable barriers by clarifying misperceptions about follow-up, promoting the acceptance of complete diagnostic evaluations, addressing psychological distress, and making follow-up testing more convenient and accessible. Moreover, educating the public regarding the risk factors of CRC and increasing understanding of the benefits of follow-up is also important.

Characteristic profiles among students and junior doctors with specific career preferences

BackgroundFactors influencing specialty choice have been studied in an attempt to find incentives to enhance the workforce in certain specialties. The notion of “controllable lifestyle (CL) specialties,” defined by work hours and income, is gaining in popularity. As a result, many reports advocate providing a ‘lifestyle-friendly’ work environment to attract medical graduates. However, little has been documented about the priority in choosing specialties across the diverse career opportunities.This nationwide study was conducted in Japan with the aim of identifying factors that influence specialty choice. It looked for characteristic profiles among senior students and junior doctors who were choosing between different specialties.MethodsWe conducted a survey of 4th and 6th (final)-year medical students and foundation year doctors, using a questionnaire enquiring about their specialty preference and to what extent their decision was influenced by a set of given criteria. The results were subjected to a factor analysis. After identifying factors, we analysed a subset of responses from 6th year students and junior doctors who identified a single specialty as their future career, to calculate a z-score (standard score) of each factor and then we plotted the scores on a cobweb chart to visualise characteristic profiles.ResultsFactor analysis yielded 5 factors that influence career preference. Fifteen specialties were sorted into 4 groups based on the factor with the highest z-score: “fulfilling life with job security” (radiology, ophthalmology, anaesthesiology, dermatology and psychiatry), “bioscientific orientation” (internal medicine subspecialties, surgery, obstetrics and gynaecology, emergency medicine, urology, and neurosurgery), and “personal reasons” (paediatrics and orthopaedics). Two other factors were “advice from others” and “educational experience”. General medicine / family medicine and otolaryngology were categorized as “intermediate” group because of similar degree of influence from 5 factors.ConclusionWhat is valued in deciding a career varies between specialties. Emphasis on lifestyle issues, albeit important, might dissuade students and junior doctors who are more interested in bioscientific aspects of the specialty or have strong personal reasons to pursue the career choice. In order to secure balanced workforce across the specialties, enrolling students with varied background and beliefs should be considered in the student selection process.

The impact of breast cancer on employment among Japanese women.

The Impact of Breast Cancer on Employment among Japanese Women: Nobue SAITO, et al. Department of Public Health, Dokkyo Medical University School of Medicine—

Comprehensive geriatric assessment in elderly breast cancer patients

Treatment of elderly patients with breast cancer is limited by the lack of evidence-based medicine due to exclusion of elderly persons from clinical studies and the difficulty of decision-making in an elderly population comprising subjects with heterogeneous health backgrounds. Individual variation of health conditions is larger in elderly patients than in young people. Since the risk–benefit balance of treatment depends on the health background, judgment of the vulnerability of individual patients is required in treatment planning. The comprehensive geriatric assessment (CGA) is a tool for acquisition of information for design of a cancer treatment plan based on evaluation of the vulnerability of elderly patients from various perspectives. The domains of the CGA include physical function, comorbidity, cognitive function, psychological status, social support system, nutrition, and medication. The CGA can be used to predict survival and adverse events; to identify health problems that cannot be detected based on medical history or examination; to recognize new problems that emerge during course observation; and to improve psychological conditions. However, application of the CGA in routine clinical practice requires establishment of a consensus regarding the survey method, evaluation scale, and use of results in decision-making. A prospective investigation of the CGA as an outcome index in elderly breast cancer patients is required to address these issues.

Unmet Information Needs and Quality of Life in Young Breast Cancer Survivors in Japan.

Background: Young breast cancer survivors have specific needs related to age. Clarifying the relationships between unmet information needs and quality of life (QOL) in young breast cancer survivors can contribute to constructing a support system to enhance QOL in patients. Objective: This study aimed to identify the unmet information needs and examine the relationships between unmet information needs and QOL in young breast cancer survivors in Japan. Methods: Participants completed an information needs questionnaire containing 26 items, the World Health Organization Quality of Life Instrument–Short Form (WHOQOL-BREF), and a demographic and medical information questionnaire. Results: Fifty participants (30.7%) were unsatisfied with “overall communication with medical professionals.” The mean scores on all subscales of the WHOQOL-BREF of the participants who were satisfied with “overall communication with medical professionals” were significantly higher than those of the unsatisfied group. “follow-up tests,” “treatment for recurrence of breast cancer,” “strategies about communication with medical staff,” and “nutrition” were significantly related with all subscales in the WHOQOL-BREF. “Secondary menopause caused by hormonal therapy” was significantly related with physical and psychological health. Conclusions: Japanese young breast cancer survivors have unmet information needs, including age-specific issues. These unmet information needs are related to QOL. In particular, “overall communication with medical professionals,” which is the most unmet information need, is related to QOL. Implications for Practice: Oncology nurses should teach patients communication skills, provide adequate information, and provide education and emotional support to medical professionals to improve QOL in young breast cancer survivors.

Psychosocial distress among young breast cancer survivors: implications for healthcare providers

Breast cancer (BC) experiences foster serious psychosocial problems among young survivors. Previous studies have repeatedly discussed younger age as a factor that puts women with BC at higher risk of psychosocial distress. Although most BC survivors receive the necessary information from healthcare providers on treatment options and procedures at diagnosis, they often fail to receive support and guidance after acute treatment has completed in dealing with the possible physical, emotional, social, and psychological effects of cancer. This article discusses common psychosocial problems experienced by young BC survivors, such as issues related to interpersonal relationships, sexuality, fertility, and employment. In particular, it examines influences of the Japanese sociocultural background on young survivors’ distress and considers the clinical implications for Japanese healthcare. The importance of integrating psychosocial care with routine oncology care cannot be overemphasized.

Impact of childhood cancer on maternal employment in Japan.

Background: Family members of children with cancer experience various long-term effects as a result of cancer diagnosis and treatment. Therefore, comprehensive and long-term support is needed. As the employment rate of women has increased in recent years, support for working mothers with children diagnosed with cancer is also required. Objective: We investigated the following issues and relevant changes that working mothers of children diagnosed with cancer must deal with: (1) work change, (2) stress, (3) social support, (4) work motivation, and (5) employment status after diagnosis. Methods: A cross-sectional exploratory study design was used. Data were collected from 62 mothers of children who were diagnosed with cancer using self-report questionnaires. Results: Of the 32 mothers who worked at the time of diagnosis, 10 continued to work, 12 took an extended leave, and 10 quit working, and 70% lost motivation for work following diagnosis. Half of mothers who continued to work during treatment reported financial reasons. Conclusions: These findings indicate that mothers who quit work following diagnosis did not initially consider a long leave of absence. Even mothers who continued to work during treatment desired a long leave of absence to care for their children. Implications for Practice: Nurses should provide mothers with explanations of the prospects after the completion of cancer treatment and determine their expectations for their lifestyle and work during treatment. We recommend that nurses confirm mothers’ willingness to take a long leave of absence from work and give relevant advice about seeking financial assistance.