The purpose of this dissertation was to examine whether a breast cancer survivor’s view of God influences her religious coping strategies, depression, anxiety, stress, fear of recurrence, and psychological well-being. These variables were selected based on literature that demonstrates relationships among them for breast cancer survivors. The specific aims of this dissertation were to: 1) identify religious coping strategies common to each of the four views of God; 2) examine the relationship of psychological well-being (Ryff) and religious coping strategies; and 3) examine differences in depression, anxiety, stress, fear of recurrence, and psychological well-being among women holding various views of God. Three manuscripts comprise this dissertation. The first manuscript is a systematic review of the literature describing what is known about the relationships between psychological adjustment and religion/spirituality (R/S) in women with breast cancer. The second manuscript examines the psychometric properties of the Image of God Scale in a population responding to a crisis event, women with breast cancer. The original scale was developed from a general population survey. Finally, the third manuscript investigates the relationships between view of God, religious coping strategies, and psychological adjustment in women with breast cancer. The systematic review identified three primary themes: 1) R/S domains and psychological adjustment; 2) dynamics of R/S conservation and struggle; and 3) reframing the cancer experience. The psychometric analysis confirmed the original 2-factor model with factor loadings ranging from .56 to .83. Cronbach’s alphas for the two subscales – belief in God’s anger (.80) and belief in God’s engagement (.89) – were consistent with those established at development. Differences were found between views of God and use of religious/spiritual coping strategies focused on Spiritual Conservation and Spiritual Struggle. Psychological Well-Being (SPWB) was inversely correlated with Spiritual Struggle. Differences were noted for psychological well-being, Fear of Recurrence, and the Stress subscale in women who viewed God as highly engaged or not. No differences were noted for the same variables in women who view God as more or less angry. Direct comparisons between groups and variations in outcomes based on common views of God could lead to effective screening for persons at risk for particular outcomes and to effective individualized interventions.

Background: Disparities exist in mortality rates in African American breast cancer survivors (AABCS), partly due to modifiable lifestyle behaviors. Gaps remain in developing effective tools to assess AABCS' motivations to prevent weight gain. Conceptual Framework: This research study used the Theory of Planned Behavior (TPB) to guide development of the elicitation study and the AABCS-Weight Gain Prevention Intention Questionnaire (AABCS-WGPIQ). Purpose: Aim One was to use the elicitation approach of the TPB to identify, define and describe AABCS' salient behavioral (advantages/disadvantages), normative (social influence) and control (facilitators/barriers) beliefs related to the prevention of post diagnosis weight gain. Aim Two was to develop and pilot test a questionnaire based on qualitative data to quantify the magnitude of influences of attitudes, subjective norms and perceived behavioral controls related to intentions to prevent weight gain in AABCS. Methods: Guided by the TPB, this cross-sectional, descriptive study used an internet based qualitative elicitation questionnaire to identify salient beliefs of 27 AABCS regarding their motivations to prevent weight gain and inform development of the quantitative AABCS-WGPIQ. Initial psychometric testing of the questionnaire included content and face validity and temporal stability assessment of belief constructs, using the test-retest approach. Findings: Aim One: Motivators to preventing weight gain among AABCS included improving health and well-being (advantages), social support from family and friends (approvals), external support systems, and personal accountability (facilitators). Time and effort required preventing weight gain (disadvantages), lack of social support (disapprovals), and time constraints, lack of accountability, unhealthy eating and health issues (barriers) negatively influenced AABCS' decisions to prevent weight gain. Future interventions aiming to increase motivation to prevent weight gain in AABCS should emphasize positive benefits of preventing weight gain, include social support systems, focus on skill building for time management, planning and goal setting, managing health issues and incorporate weight loss management strategies. Aim Two: The AABCS-WGPIQ has acceptable content validity, face validity and temporal stability of belief constructs. The AABCS-WGPIQ has the potential to be a valid instrument for assessing correlates of weight gain prevention in AABCS. Future research with larger groups of AABCS should include assessing internal consistency and construct validity.

Thesis advisor: Jane Flanagan / BACKGROUND: Breast cancer survivors experience a range of needs in the post-treatment phase as they transition into survivorship and beyond. The transition to survivorship requires breast cancer survivors to actively engage in self-managing their care, but little is known about patient engagement into survivorship care and what factors may contribute to this. Information is needed to further explore patient engagement into survivorship care, what factors may contribute to it and which patients are more likely to engage in their care and thus be better equipped to self-manage during survivorship. PURPOSE: The purpose of this study was to explore how demographic/personal factors and survivorship outcomes are related to and may contribute to patient engagement in early stage breast cancer survivors. METHODS: A cross-sectional, web-based self-report national survey was conducted using measures assessing personal/demographic factors, survivorship outcomes: health-related quality of life (HRQOL), fear of cancer recurrence (FCR), cancer health literacy (CHL) and two measures of patient engagement (patient activation (PA) and knowing participation in change (KPC). There was one open-ended question regarding additional survivorship concerns, not addressed in the previous survey items. Participants were recruited using Dr. Susan Love’s Army of Women Research Foundation and Craigslist. Data were analyzed via bivariate associations and backwards linear regression modeling in SPSS. RESULTS: The final sample included 303 participants (301 females and 2 males) with a mean age of 50.70 years. The sample was predominantly White, non-Hispanic and equally dispersed across the United States. Patient engagement, as represented by PA and KPC, was significantly correlated with 13 predictor variables and there were 10 predictor variables that resulted in significant ANOVA relationships with PA and KPC. In both the KPC and PA regression models, HRQOL significantly predicted for patient engagement. In the KPC regression model, social support and level of education also significantly predicted for patient engagement and receipt of a survivorship care plan contributed unique variance to the model. The open-ended question response categories included: physical concerns, mental health concerns, financial toxicity, social support, body image concerns, other concerns or no concerns/none. CONCLUSIONS: This study provides preliminary evidence that personal/demographic factors and survivorship outcomes may contribute to patient engagement in breast cancer survivors. Using assessment tools that measure factors such as HRQOL, social support, education level and patient engagement may give providers some insight as to which survivors may be ready to engage in survivorship care and those that may need more resources and/or support. Additional studies are needed to replicate and validate these results. More research is needed aimed at maximizing patient-centered care, patient engagement and ultimately improving SC. Keywords: breast cancer survivor, survivorship, patient engagement, health-related quality of life, social support. / Thesis (PhD) — Boston College, 2019. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

The aim of the present study was to determine if a nutrition and yoga intervention will improve quality of life (QoL) in breast cancer survivors (BCS). Using the Transactional Model of Stress and Coping as a guide to lead the intervention, the intervention assessed potential barriers, self-efficacy, diet quality, and physical activity as it relates to quality of life. Twenty-seven women were enrolled in the study and randomly assigned to the control or intervention group. The intervention consisted of 6-weeks of yoga classes and 6-weeks of online nutrition education. The control group received a nutrition consultation and nutrition guidelines from the American Cancer Society. Measurement of variables was conducted at baseline, post-intervention (6 weeks), and follow-up (12 weeks). One-way repeated measures ANOVA, paired samples t-test, and post hoc analysis with Bonferroni adjustment was used to analyze the data. Mediation analysis with regression was performed to demonstrate the effect the intervention had on quality of life. The intervention elicited a statistically significant difference in the Total Outcome Index quality of life score from baseline to post-intervention (P < .005) and from baseline to follow-up (P < .005) in the intervention group. The frequency of how often fruits and vegetables were consumed was significant between time points, (P < .05), but not between the control and intervention group, P = .538. The amount of fruit and vegetables consumed each time was statistically significant for the intervention group from baseline to post-intervention (P < .05) however there was no significant difference from baseline to follow-up (P = .067). There was no difference between the control and intervention group, (P = .216). There was a statistically significant difference for physical activity for time (P P = .166) however the intervention group has a statistically significant difference between baseline and post-intervention (PP = .082). We cannot confidently predict that participant’s quality of life scores are determined by group with the help of mediators after conducting a mediation analysis with regression. A six-week nutrition and yoga intervention in BCS elicited significant changes in QoL in BCS. Even though the results did not show significant changes between the control and intervention group there were significant changes within the intervention group from baseline to post-intervention and baseline to follow-up which may indicate a 6-week online nutrition education program coupled with a 6-week yoga intervention an effective tool to improve QoL in BCS.

Purpose: The purpose of this thesis was to perform a scoping review of the current literature and available clinical practice guidelines to generate an understanding of the primary health care needs of women following treatment for breast cancer. Methods: Based on an extensive scoping review of the literature, research findings regarding the complications of breast cancer treatments and corresponding primary care interventions were synthesized. Additionally, validation of the findings of the scoping review was performed through semi-structured interviews with two primary care physicians and three post-treatment breast cancer patients. Results: Eleven broad categories related to the primary health care needs of women after undergoing treatments for breast cancer were identified. These included concerns related to: surgical complications, lymphedema, gynecologic and menopausal symptoms, psychosocial issues, additional primary cancers, cardiovascular implications, osteoporosis, lifestyle changes, fatigue, cognitive dysfunction, and pregnancy. Additionally, it was determined that the majority of existing clinical practice guidelines for breast cancer were outdated, and related to cancer detection and treatment as opposed to survivorship care. Summary: Findings from the scoping review and interviews demonstrate the vast range of primary care needs of women after undergoing treatment for breast cancer. Additionally, these results highlight the critical need for the development of a comprehensive set of current clinical practice guidelines which target primary care physicians and are specifically focused on the survivorship needs of women following breast cancer treatment. / Thesis (Master, Rehabilitation Science) -- Queen's University, 2011-07-22 16:09:35.682

Indiana University-Purdue University Indianapolis (IUPUI) / Long-term survivors (LTSs) of breast cancer are defined as patients who have been in remission for a year or longer. Even after being declared breast-cancer-free, many LTSs have questions that were not answered by clinicians. Although online resources provide some content for LTSs, none, or very little, provide immediate answers to specific questions. Thus, the aim involves proposing specifications for a system, the Health Electronic Learning Platform (HELP), that can assist survivors by becoming an all-inclusive resource for LTSs of breast cancer. To achieve this, relevant information from the literature was used to assess the needs of LTSs. Also, data from a study involving the breast cancer survivor’s forum project that had been filtered to include posts with mentions of features to be added to the website and usability issues encountered. To complete the actual design of the system, a synthesis of the results obtained from these two sources was performed. HELP is simple in terms of its layout and consists of a main search-bar, where LTSs are able to ask questions using their own terms and language. This navigator should not be taken as definitive solution, but instead, should be used as a starting point toward better patient-centered care.

No description available.

After cancer patients have completed active cancer treatment, they have specific follow-up care needs. These needs include ongoing surveillance for new and recurring cancers, managing the side effects of cancer treatment, and psychosocial concerns (Rushton et al., 2015). In the past, cancer centres and oncology specialists provided follow-up care; however, new models of care are needed because cancer centres can no longer provide treatment and follow-up care to all cancer survivors (Jefford et al., 2022). To allocate health care resources, low risk cancer survivors (i.e., breast and colorectal cancer survivors) are being discharged from cancer centres after primary treatment back to their primary care provider (PCP) for follow-up care. Survivorship care plans (SCPs) have been identified as a tool to help survivors and their PCPs with this transition (Rushton et al., 2015). SCPs generally consist of a treatment summary, a schedule for follow-up and surveillance tests, and general health recommendations (i.e., diet and exercise; Howell et al., 2011; Ruston et al., 2015). While SCPs are widely accepted, research on their effectiveness as transition tools has been inconclusive (Hill et al., 2019; Jacobsen et al., 2018). Some studies show positive, neutral, and negative impacts of SCP use, and there are three potential reasons for these mixed findings: 1) there is wide variety in the content, format, delivery, and timing of SCPs which adds considerable variance when studying the impact of SCPs; 2) the use of outcomes to measure the usefulness of SCPs as transition tools that are beyond the scope that information about treatment history and follow-up guidelines could impact and; 3) that SCPs are not effective as transition tools (Hill et al., 2019; Jacobsen et al., 2018). An important first step in clarifying whether SCPs are effective transition tools is to understand how SCPs are being used in real world practice (Hill et al., 2019; Jacobsen et al., 2018). The overall purpose of this study was to develop best practice recommendations for implementing SCPs. This was achieved through three study objectives: 1) to comprehensively identify barriers and facilitators perceived to influence SCP use among cancer survivors and primary care providers (PCPs); 2) to identify evidence-based approaches to address barriers and enhance facilitators of SCP use; and 3) to develop best practice recommendations that can be used by implementors of SCPs that are adaptable across different contexts. Article 1 presents the results of semi-structured interviews with breast and colorectal cancer survivors who had received a SCP at least 12 months prior to the interview. The interviews were based on the Theoretical Domains Framework, version two (TDF-2; Cane et al., 2012) and comprehensively identified barriers and facilitators of SCP use amongst breast and colorectal cancer survivors. Thirty cancer survivors (17 female, 13 male) participated in the 30–45-minute interviews, which were then analyzed using content and thematic analysis. Survivors who had received education about the purpose of SCPs and how to use them reported finding their SCP helpful and that they used it to schedule appointments and communicate with their healthcare providers. Barriers to SCP use that were reported by cancer survivors included having lost or not remembering receiving a SCP, not understanding the importance of their SCP, and wanting information about additional supports to be able to follow the SCP (e.g., regular contact from the cancer centre, avenues for peer support). Overall, study 1 found that in order to SCPs to be used as intended transition tools, survivors benefit from receiving education about how to use them and be informed of the expectation that they be actively involved in their follow-up care. Article 2 presents the TDF-based semi-structured interviews with primary care providers (PCPs). Thirteen PCPs completed 15-20 minute interviews, and content and thematic analysis was conducted. PCPs reported finding SCPs helpful and that they contained relevant information to provide follow-up care. A key facilitator of using the SCP was the table of follow-up tasks (e.g., mammography, colonoscopy) and their frequencies included in the SCP. Two significant barriers for PCPs using SCPs were: a) logistical issues with ordering follow-up tests and receiving results; and b) a lack of clear avenues to consult with oncology specialists (e.g., managing side effects of medications, actions that need to be taken when follow-up tests are abnormal). Overall, article 2 showed that PCPs appreciate and readily use SCPs, and contextual changes to facilitate clear avenues of communication between primary and tertiary care may be beneficial when implementing SCPs. Article 3 is a methodology article that presents a detailed explanation and rationale for the implementation science frameworks used and the data analysis chosen. The TDF-2 and Behaviour Change Techniques Taxonomy (BCTTv1; Michie, et al., 2008; Michie et al., 2013). The Human Behaviour Change Project researchers have empirically linked the 14 TDF domains to behaviour change techniques (BCTs), which allowed for multiple options to be developed to address barriers (and promote facilitators) of SCP use among breast and colorectal cancer survivors and PCPs (https://theoryandtechniquetool.humanbehaviourchange.org/tool; Michie et al., 2021). Using the TDF and BCTTv1 showed a dynamic between oncology specialists (e.g., oncologists, oncology nurses), cancer survivors, and PCPs that is involved in ensuring SCPs are implemented in an optimal way. A logic model was used to organize the barriers and enablers into different phases of SCP development, content, delivery, and use by PCPs and cancer survivors in their follow-up care (Mills et al., 2019). A flowchart organizing the recommendations of implementing SCPs was developed, and comprised 10 steps representing interrelationships between cancer centers, PCPs, and cancer survivors. The detailed methodology article also includes lessons learned and suggestions for implementation science researchers using the TDF and BCTTv1. Finally, article 4 is written for anyone looking for guidance implementing SCPs or improving upon how SCPs have been implemented already. It differs from article 3 in that it provides practical solutions for implementers. Because this work generated many recommendations, article 4 provides a worked example of how to use the results of this study. It is written in a way that outlines who would benefit from using the recommendations, and how to use the flow chart to narrow down the recommendation to those most relevant to implementors. The recommendations are organized into one of the 10 relationships in the flow chart, along with the purpose of the recommendations, how to implement it, to whom the recommendation targets, and those responsible for enacting the recommendations. The core factors associated with facilitating SCP use by PCPs and cancer survivors were: a) a treatment summary and follow-up guidelines included in the SCP; b) SCP provided to both cancer survivors and their PCP; and c) educating cancer survivors about their role as self-managers of their own care and the expectation that they participate in their follow-up cancer care. Future research on the usefulness of SCPs in follow-up care should include detailed information about the content, format, and receivers of SCPs and the outcomes most realistically influenced by the information included in SCPs. Before throwing the proverbial baby out with the bathwater, the implementation of SCPs requires additional standardization before meaningful investigation of their effectiveness as transition tools can be conducted.