Managing Uncertainty: Self-Help in Breast Cancer
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Summary of Findings
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Summary of Findings Final Report of “Managing Uncertainty: Self Help in Breast Cancer” In this study a psycho-educational intervention found successful with younger and primarily Caucasian women was tested for its beneficial effect when delivered to lower income elderly white and minority women. The telephone-delivered intervention taught these women uncertainty management as a means of enhancing self-care and self-help behavior .The purpose of this investigation was to test the usefulness of a similar telephone-delivered intervention in assisting low SES, elderly, white and minority women to manage uncertainty in the illness experience in order that they may be able to care for themselves while receiving treatment for breast cancer. Subjects were blocked on ethnicity and randomly assigned to treatment and control groups from each block. Data were collected at baseline (time 1), four months post baseline (time 2) and seven months post baseline (time 3). The sample consisted of 305 women with a mean age of 63 (SD=9.1) and was comprised of three ethnic groups: 106 Caucasian women, 104 African-American women and 95 Mexican American women. The Caucasian and African-American women were recruited from health care facilities in North Carolina and the Mexican-American women from health care facilities in Arizona where the sub-contract site was at the University of Arizona. Subjects were randomly assigned to treatment and control conditions with 147 subjects in the experimental group and 158 subjects in the control group. Although there are a number of differences by ethnic groups at baseline, these differences are not evident when a comparison is done between experimental and control. This provides evidence that randomization was effective in controlling for ethnic group differences. Between ethnic groups significant differences were found in the demographics of age, education, tumor stage, and treatments with Mexican-American women having higher rates of biopsy and axillary node dissection and higher rates of chemotherapy then Caucasian and African-American women. Whether these differences can be attributed to ethnicity or to regional differences in approach to diagnosis and treatment can not be determined. Findings Findings include information about the major types of problems experienced by Caucasian, African-American and Mexican-American women who received the intervention. Information is also available about the major interventions delivered to help the women manage the uncertainty associated with their problems. For Caucasian women, the top five problems reported were, in descending order of frequency, fatigue, medical uncertainty, ability to cope, implementing self- care behaviors, and managing their appearance and body image. For African-American women the top five problems were financial issues, fatigue implementing self-care behaviors, nausea and expectation about treatment. For Mexican-American women the top five problems were medical uncertainty, financial issues, implementing self- care behaviors, pain and threat of recurrence. All women shared the problem of how to care for themselves and manage their treatment side-effects. Both Caucasian and Mexican-American women were concerned about the lack of medical certainty associated with their disease. Both groups of minority women had financial concerns and had lower income levels than Caucasian women. Results A repeated measure MANCOVA was run to address research questions. Education was treated as the co-variate. Although education did not differ between the treatment and control groups, it is seen as representative of socio-economic status and controls for SES differences across groups. All women who received the intervention had significantly higher levels of cognitive reframing as compared to control subjects. Cognitive reframing refers to the ability to reframe the concern into something that is manageable. Cancer knowledge was also significantly higher in all women who received the intervention as compared to controls. On the measure of patient-provider communication, women who received the intervention also rated themselves as receiving more information from the nurse as compared with control subjects. In the analysis for significant different by ethnic group comparing intervention versus controls, Caucasian women who received the intervention had higher levels of problem-solving from baseline to 4 months post baseline as compared to their control group. Similar findings were found for the variable of patient-provider communication. Caucasian women who received the intervention reported getting more information from their doctor from baseline to 4 months post baseline as compared to their controls. For African-American women, those who received the intervention reported better symptom management in that they had fewer treatment side-effects over time, lower levels of symptom intensity over time, less nausea and less fatigue over time as compared to their controls. Mexican-American women who received the intervention also reported better symptom management in that they reported greater ability to manage their appearance from baseline to 4 months post baseline as compared to their control subjects, a greater increase in appetite, and better management of hair loss from 4 months to 7 months post baseline than did their controls. Overall this was the first intervention study to include only older women and two groups of minority women. It is clear from the results that women in each group benefited from the intervention. However, of the three groups of women who received the intervention, Caucasian women reported more gains in communication with providers and in cognitive skills such as problem solving. African-American women and Mexican-American women reported more benefits from the intervention in reduction in treatment side effects and these gains lasted over time.
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