Mohammed Al-Azri

Coping With a Diagnosis of Breast Cancer-Literature Review and Implications for Developing Countries

Abstract:u2002 Breast cancer is the most common cancer affecting women worldwide. Women are at an increased risk of developing both physical and psychological morbidity after diagnosis; however, many use different strategies to cope with the disease. The aim of this article is to review the available literature on the impact of breast cancer diagnoses and the strategies used by women to cope with this disease. The implications of these emerging findings are extrapolated within the context of health services provided in developing countries. Electronic databases were used to search the relevant literature. The findings showed that women who were diagnosed with breast cancer are at risk of developing several psychological morbidities such as depression, anxiety, fatigue, negative thoughts, suicidal thoughts, fear of dying, sense of aloneness, sexual and body images problems, as well as an overall decrease in the quality of life. Several strategies are used by women with breast cancer to cope with the disease, including positive cognitive restructuring, wishful thinking, emotional expression, disease acceptance, increased religious practice, family and social support, and yoga and exercise. Breast cancer diagnoses have been associated with several devastating psychological consequences; however, many women have used different coping strategies to adjust their lives accordingly. Healthcare professionals in developing countries, who work with women with breast cancer, should be aware of the different coping mechanisms that women use when diagnosed with cancer. Integrating a coping strategy into the treatment regimen would constitute an important milestone in the palliative care of patients with breast cancer.

Coping with a diagnosis of breast cancer among Omani women

The aim of this study was to identify coping strategies experienced by Omani women after breast cancer diagnosis. Individual semistructured interviews were conducted with 19 women diagnosed with breast cancer. Several coping strategies were identified including denial, optimism, withdrawal, Islamic beliefs and practices, and the support of family members and health-care providers, but Islamic beliefs and practices were the commonest. Health-care professionals should be aware of and respect women’s coping strategies and encourage them to use to reduce the psychological symptoms. They should also make family members and friends aware of their role in supporting and encouraging coping strategies.

Awareness of risk factors for cancer among Omani adults--a community based study.

BACKGROUNDnCancer is the leading cause of mortality around the world. However, the majority of cancers occur as a result of modifiable risk factors; hence public awareness of cancer risk factors is crucial to reduce the incidence. The objective of this study was to identify the level of public awareness of cancer risk factors among the adult Omani population.nnnMATERIALS AND METHODSnA community based survey using the Cancer Awareness Measure (CAM) questionnaire was conducted in three areas of Oman to measure public awareness of cancer risk factors. Omani adults aged 18 years and above were invited to participate in the study. SPPSS (ver.20) was used to analyse the data.nnnRESULTSnA total of 384 participated from 500 invited individuals (response rate =77%). The majority of respondents agreed that smoking cigarettes (320, 83.3%), passive smoking (279, 72.7%) and excessive drinking of alcohol (265, 69%) are risks factors for cancer. However, fewer respondents agreed that eating less fruit and vegetables (83, 21.6%), eating more red or processed meat (116, 30.2%), being overweight (BMI>25) (123, 32%), doing less physical exercise (119, 31%), being over 70 years old (72, 18.8%), having a close relative with cancer (134, 34.9%), infection with human papilloma virus (HPV) (117, 30.5%) and getting frequent sunburn during childhood (149, 38.8%) are risk factors for cancer. A significant association was found between participant responses and their educational level. The higher the educational level, the more likely that respondents identified cancer risk factors including smoking (p<0.0005), passive smoking (p= 0.007), excessive drinking of alcohol (p<0.0005), eating less fruit and vegetables (p= 0.001) and infection with HPV (p<0.0005).nnnCONCLUSIONSnThe majority of respondents in this study in Oman were not aware of the common risk factors for cancer. It may be possible to reduce the incidence of cancers in Oman by developing strategies to educate the public about these risk factors.

Prevalence and Risk Factors of Antenatal Depression among Omani Women in a Primary Care Setting: Cross-sectional study

OBJECTIVESnThis study aimed to identify the prevalence of antenatal depression and the risk factors associated with its development among Omani women. No previous studies on antenatal depression have been conducted in Oman.nnnMETHODSnThis descriptive cross-sectional study was carried out between January and November 2014 in Muscat, Oman. Pregnant Omani women ≥32 gestational weeks who were attending one of 12 local primary care health centres in Muscat for routine antenatal care were invited to participate in the study (n = 986). An Arabic version of the validated self-administered Edinburgh Postnatal Depression Scale questionnaire was used to measure antenatal depression. A cut-off score of ≥13 was considered to indicate probable depression.nnnRESULTSnA total of 959 women participated in the study (response rate: 97.3%). Of these, 233 were found to have antenatal depression (24.3%). A bivariate analysis showed that antenatal depression was associated with unplanned pregnancies (P = 0.010), marital conflict (P = 0.001) and a family history of depression (P = 0.019). The adjusted odds ratio (OR) after logistic multivariate regression analysis showed that antenatal depression was significantly associated with unplanned pregnancies (OR: 1.37; 95% confidence interval [CI]: 1.02-1.86) and marital conflict (OR: 13.83; 95% CI: 2.99-63.93).nnnCONCLUSIONnThe prevalence of antenatal depression among the studied Omani women was high, particularly in comparison to findings from other Arab countries. Thus, antenatal screening for depression should be considered in routine primary antenatal care. Couples should also be encouraged to seek psychological support should marital conflicts develop during pregnancy.

Psychosocial Impact of Breast Cancer Diagnosis Among Omani Women

OBJECTIVESnThe aim of this study was to explore different psychosocial impacts on Omani women diagnosed with breast cancer.nnnMETHODSnSemi-structured individual interviews were conducted with 19 Omani women diagnosed with breast cancer to describe the impact of the disease on their personal and social life. Women were recruited from wards and out-patient clinics at the Sultan Qaboos University Hospital, Muscat.nnnRESULTSnFour main themes emerged. These were: a) factors related to psychological distress of the disease and uncertainty (worry of death, interference with work and family responsibilities, searching for hope/cure, travelling overseas); b) reactions of family members (shocked, saddened, unity, pressure to seek traditional treatments); c) views of society (sympathy, isolation, reluctant to disclose information); and d) worries and threats about the future (side effects of chemotherapy, spread of the disease, effect on offspring).nnnCONCLUSIONnBreast cancer diagnosis has several devastating psychosocial impacts on women in Oman. Healthcare professionals working with women with breast cancer should be aware of the different psychosocial impacts of the disease on womens lives. Appropriate measures must be taken by the decision makers whenever needed, including enforcing positive views and support of Omans society towards women with breast cancer.

A survey of community members' perceptions of medical errors in Oman

BackgroundErrors have been the concern of providers and consumers of health care services. However, consumers perception of medical errors in developing countries is rarely explored. The aim of this study is to assess community members perceptions about medical errors and to analyse the factors affecting this perception in one Middle East country, Oman.MethodsFace to face interviews were conducted with heads of 212 households in two villages in North Al-Batinah region of Oman selected because of close proximity to the Sultan Qaboos University (SQU), Muscat, Oman. Participants perceived knowledge about medical errors was assessed. Responses were coded and categorised. Analyses were performed using Pearsons χ2, Fishers exact tests, and multivariate logistic regression model wherever appropriate.ResultsSeventy-eight percent (n = 165) of participants believed they knew what was meant by medical errors. Of these, 34% and 26.5% related medical errors to wrong medications or diagnoses, respectively. Understanding of medical errors was correlated inversely with age and positively with family income. Multivariate logistic regression revealed that a one-year increase in age was associated with a 4% reduction in perceived knowledge of medical errors (CI: 1% to 7%; p = 0.045). The study found that 49% of those who believed they knew the meaning of medical errors had experienced such errors. The most common consequence of the errors was severe pain (45%). Of the 165 informed participants, 49% felt that an uncaring health care professional was the main cause of medical errors. Younger participants were able to list more possible causes of medical errors than were older subjects (Incident Rate Ratio of 0.98; p < 0.001).ConclusionThe majority of participants believed they knew the meaning of medical errors. Younger participants were more likely to be aware of such errors and could list one or more causes.

Patients' attitudes and experiences of relational continuity in semi-urban general practices in Oman.

BACKGROUNDnRelational continuity is a cornerstone of primary care. In developing countries, however, little research has been conducted to determine the perception and experiences of patients in view of relational continuity in primary care.nnnOBJECTIVEnTo study the role of relational continuity in primary care settings and its effect on patients perceptions and experiences.nnnMETHODSnA questionnaire-based survey was conducted at eight primary care health centres (PCHCs) in Al-Seeb province, Muscat, the capital city of Oman. All Omani patients aged 18 years and above attending their PCHCs during the study period were invited to participate in the study.nnnRESULTSnFrom a total of 1300 patients invited, 958 Omani patients agreed to participate in the study (response rate = 74%). More than half of the patients (61%) expressed the preference of consulting the same primary care physician (PCP) to whom they were accustomed. This increased to 69% if the patients had psychosocial problems and to 71% if the patients had chronic medical conditions. A significant proportion of the respondents (72%) felt comfortable and relaxed when consulting the same PCP and 67% expressed an interest in maintaining continuity with the same PCP. The general perspective held by the majority of the studied patients (61%) indicated that relational continuity improved both the patients medical conditions (51%) and the quality of services (61%). In actuality, however, only 18% experienced relational continuity in their PCHCs. The preference for relational continuity was significantly increased among patients who identified a favourite PCP (P = 0.029) and among educated patients (P = 0.023).nnnCONCLUSIONnAlthough it is relatively difficult to consult with the same PCP, the majority of Omani patients have experienced several benefits from relational continuity within the context of patient-physician relationship. The preference for relational continuity was highly expressed by patients with chronic or psychosocial problems, patients who were educated and those who identified a named PCP. In view of these findings, the basis of relational continuity if progressed, a great effort is needed to develop and implement strategies to promote relational continuity in primary health care in Oman.

Public awareness of warning signs and symptoms of cancer in Oman: A community-based survey of adults

BACKGROUNDnThe majority of deaths from cancer occur in low and middle income countries, partly due to poor public awareness of the signs and symptoms of cancer.nnnMATERIALS AND METHODSnA community based survey using the Cancer Awareness Measure (CAM) questionnaire was conducted in three different communities in Oman. Omani adults aged 18 years and above were invited to participate in the study.nnnRESULTSnA total of 345 responded from 450 invited participants (response rate=76.7%). The majority of respondents were unable to identify the common signs and symptoms of cancer identified in the CAM (average awareness was 40.6%). The most emotional barrier to seeking help was worry about what the doctor might find (223, 64.6%); a practical barrier was too busy to make an appointment (259, 75.1%) and a service barrier was difficulty talking to the doctor (159, 46.1%). The majority of respondents (more than 60% for seven out of ten symptoms) would seek medical help in two weeks for most signs or symptoms of cancer. Females were significantly more likely than males to be embarrassed (p<0.001), scared (p=0.001), and lack confidence talking about their symptoms (p=0.022).nnnCONCLUSIONSnUrgent strategies are needed to improve public awareness of the signs and symptoms of cancer in Oman. This might leads to earlier diagnosis, improved prognosis and reduced mortality from cancer.

Delay in Cancer Diagnosis: Causes and Possible Solutions

Cancer is the leading cause of death in developed and developing countries. Cancer mortality is expected to rise to an estimated 13.1 million deaths annually by 2030.1 However, certain types of cancer have a high chance of cure if they are detected at an early stage and adequately treated.2 n nThe delays in cancer diagnosis may occur throughout the diagnostic pathway: patient, primary care, and secondary care. Patient delays may occur when the patient fails to recognise and act on suspicious cancer symptoms.3 Poor public awareness for early symptoms of cancer is considered to be the predominant reason for delayed presentation, particularly if symptoms are atypical in nature.4 A recent community-based study measuring public awareness of cancer symptoms in Oman showed that the majority of Omanis were unable to identify common cancer symptoms. These included unexplained bleeding, difficulty swallowing, change in bowel or bladder habits, sores that did not heal, unexplained pain, cough or hoarseness, unexplained lump or swelling, change in the appearance of a mole, and unexplained weight loss. The study also showed that the most reported barriers to seeking timely medical help included being too busy to make an appointment, concern about what the doctor might find, and difficulty talking to the doctor. The study concluded that urgent strategies are needed to increase public awareness in Oman for ncancer symptoms.5 n nThe Oman Cancer Association (OCA) is a non-governmental organization working to increase public awareness of cancers using community-based programs. The association works to educate the community about early symptoms of cancer, promote self-examination for cancer (e.g., breast cancer) and promote proper, timely intervention. However, still more public educational activities are needed, particularly in the rural communities. n nAlthough the school science curriculum in Oman covers many concepts related to health education, none of them are related to awareness of risk factors for cancer or cancer symptoms.6 Thus, curriculum-based health education regarding the prevention of cancer and motivation of children to incorporate healthy lifestyle practices into their daily lives are needed. Using media such as TV broadcasts, life lectures, seminars, and social media could improve cancer awareness among adolescents. n nPrimary care delays may occur in the recognition, investigation, and referral for symptoms suspicious of cancer.3 Although primary care is the first point of contact for patients using national health services in many countries around the world, delay in cancer diagnosis remains as an ongoing problem at this level. Primary care physicians are expected to identify patients with possible cancer at an early stage, but the diagnosis of cancer is relatively uncommon for individual primary care physician as more than 80% of patients present with non-specific symptoms.7 Indeed, the main concern of a primary care physician is to differentiate the minority of patients who need urgent attention from the majority of patients who are likely to have self-limiting conditions.8 n nPrimary health care services in Oman, similar to the most Arabic countries, are provided by a network of local health centres. However, patients can access medical services at different places, including private clinics and hospitals. Also, some patients may travel abroad for investigations, treatments, medical check-ups, and to obtain a second opinion.9 As a result, there is a serious lack of continuity of care. Continuity of care with a particular physician has been found to increase early detection of cancer and the likelihood of cancer testing.10 Thus, support is needed to increase continuity of care through promoting appointment systems and limited access to a specific primary care physician for non-urgent conditions. n nAlthough the Ministry of Health in Oman developed a guideline for early detection and screening of breast cancer in 2010, there is also a need for guidelines to identify alarming symptoms for other types of cancer and to refer suspected patients to a specialist within a specific period.11 A policy has been adopted in the UK to refer patients who are suspected of having cancer to a specialist within two weeks.12 Therefore, availability of guidelines for primary care physicians in Oman to identify suspected symptoms of cancer and refer them early to specialists are important to shorten the appointment waiting time and improve cancer prognosis. n nIn the hospital, delays can be due to the doctors’ delay in making a diagnosis and starting treatment. A doctors’ delay in making a diagnosis is defined as the time taken from primary care referral to diagnosis. Delay of treatment is defined as the interval between diagnosis and the start of treatment.13 Considerable diagnostic delay might occur if several invasive procedures are needed to confirm the diagnosis and the suitability for surgical treatment.14 n nIn summary, a delay in cancer diagnosis can occur at various levels. The patient may fail to recognise suspicious cancer symptoms or act on them. The primary care physician may not recognise patients with suspicious cancer symptoms and investigate them appropriately or refer on time. Patients with suspicious cancer in secondary care may not be seen on time, or they may be referred to the wrong specialty. Thus, using media to broadcast the message of awareness in the community should increase public knowledge of cancer symptoms and the importance of seeking timely medical attention. Regularly updating primary care physicians about alarming symptoms of cancer, developing guidelines to identify these symptoms, promoting continuity of care, and enabling access to specialist expertise through prompt referrals should all help to prevent delays in cancer diagnosis.

Awareness of Cancer Symptoms and Barriers to Seeking Medical Help Among Adult People Attending Primary Care Settings in Oman

Objectives: To explore the public’s awareness of cancer symptoms and the barriers to seeking medical help among Omani adults attending primary care settings in Muscat governorate, the capital city of Oman. Methods: The Cancer Awareness Measure (CAM) questionnaire (translated into Arabic) was used to collect data from a total of 12 randomly selected local health centers (LHCs) in Muscat governorate, the capital city of Oman. Omani adults aged 18 years and above attending LHCs during the study period were invited to participate in the study. Statistical Package for the Social Sciences (SPSS version 22) was used to analyze the data. Results: A total of 999 participants completed the CAM questionnaire from 1200 invitations (response rate = 83%). The overall recognition of common cancer symptoms was less than 50% except for an unexplained lump/swelling, which was 71%. Multinomial logistic regression showed that women recognized more cancer symptoms than men (odds ratio [OR] = 1.79; 95% confidence interval [CI]: 1.27-2.51), that more highly educated participations recognized more cancer symptoms than less educated participants (OR = 39; 95% CI: 0.23-0.69). The majority of participants (91.2%) agreed that the right time to seek medical help for possible cancer symptom was within 2 weeks. Multinomial logistic regression showed that women rather than men were more likely to perceive barriers to seeking medical help (OR = 2.10; 95% CI: 1.60-2.76). Also the less educated participants, rather than more educated, were more likely to perceive barriers to seeking medical help (OR = 2.17; 95% CI: 1.16-4.05). Conclusion: Levels of awareness of cancer symptoms are low in Oman. More national CAMs are needed in Oman to increase public knowledge of cancer symptoms. Also, more public awareness is needed to overcome the barriers to seeking timely medical help particularly among groups of women and the unmarried, widowed, divorced, or separated if delays in presentation are to be minimized.