Purpose/Objectives: To test the effect of a supportive, one-time psychoeducational intervention on treatment adherence among African American women receiving first adjuvant therapy for breast cancer.
Design: A pilot, randomized, controlled clinical trial, two-group design, with one-time intervention and four data collection points.
Setting: Two University of Pittsburgh Cancer Institute clinics.
Sample: 24 African American women.
Methods: The Attitudes, Communication, Treatment, and Support (ACTS) intervention is a 45-minute one-on-one session with an African American woman recommended to have chemotherapy for breast cancer. The interventionist is an African American breast cancer survivor. The intervention consists of a discussion about chemotherapy and the importance of communicating knowledge needs and distress, an explanation of the specific treatment plan according to pathology, and support through the survivor testimonial and video clips from the African American community.
Main Research Variables: Dose of chemotherapy received and dose of chemotherapy prescribed.
Findings: Twenty patients completed chemotherapy, and four chose not to begin or discontinued recommended chemotherapy. The groups were equal in key sociodemographic variables. Compared to usual care, the ACTS intervention participants demonstrated trends toward initiation of chemotherapy (100% versus 82%), overall adherence to chemotherapy (92% versus 73%), and percentage of total dose of chemotherapy received or prescribed (94% versus 74%). Compared to usual care, the ACTS intervention participants demonstrated more rapid initiation of chemotherapy and better overall adherence to chemotherapy.
Conclusions: The pilot ACTS intervention shows promise as a psychoeducational intervention to assist with chemotherapy decision making among African American women.
Implications for Nursing: African American women are at high risk of not receiving the full dose of prescribed chemotherapy for breast cancer for multiple reasons. Nurses must be sensitive to the unique fears and concerns of this population regarding chemotherapy decisions. An intervention addressing these fears and concerns may help to increase adherence.
Ahmed, N. U., Fort, J. G., Elzey, J. D., & Belay, Y. (2005). Empowering factors for regular mammography screening in under-served populations: Pilot survey results in Tennessee. <i>Ethnicity and Disease, 15</i>, 387-394.
American Cancer Society. (2007). <i>Breast cancer facts and figures 2007-2008.</i> Atlanta, GA: Author.
Battaglia, T. A., Roloff, K., Posner, M. A., & Freund, K. M. (2007). Improving follow-up to abnormal breast cancer screening in an urban population. A patient navigation intervention. <i>Cancer, 109</i>(2, Suppl.), 359-367. doi: 10.1002/cncr.22354
Bickell, N. A., Wang, J. J., Oluwole, S., Schrag, D., Godfrey, H., Hiotis, K., … Guth, A. A. (2006). Missed opportunities: Racial disparities in adjuvant breast cancer treatment. <i>Journal of Clinical Oncology, 24</i>, 1357-1362. doi: 10.1200/JCO.2005.04.5799
Blackman, D. J., & Masi, C. M. (2006). Racial and ethnic disparities in breast cancer mortality: Are we doing enough to address the root causes? <i>Journal of Clinical Oncology, 24</i>, 2170-2178. doi: 10.1200/JCO.2005.05.4734
Bradley, P. K. (2006). Racial and ethnic disparities in cancer care and survivorship: A research and education effort focuses on African American breast cancer survivors. <i>American Journal of Nursing, 106</i>(3, Suppl.), 22-23.
Cooper, L. A., Beach, M. C., Johnson, R. L., & Inui, T. S. (2006). Delving below the surface: Understanding how race and ethnicity influence relationships in health care. <i>Journal of General Internal Medicine, 21</i>(Suppl. 1), S21-S27. doi: 10.1111/j.1525-1497.2006.00305.x
Gordon, N. H. (2003). Socioeconomic factors and breast cancer in black and white Americans. <i>Cancer and Metastasis Reviews, 22</i>(1), 55-65. doi: 10.1023/A:1022212018158
Henderson, P. D., Gore, S. V., Davis, B. L., & Condon, E. H. (2003). African American women coping with breast cancer: A qualitative analysis. <i>Oncology Nursing Forum, 30</i>, 641-647. doi: 10.1188/03.ONF.641-647
Hershman, D., McBride, R., Jacobson, J. S., Lamerato, L., Roberts, K., Grann V., & Neugut, A. (2005). Racial disparities in treatment and survival among women with early-stage breast cancer. <i>Journal of Clinical Oncology, 23</i>, 6639-6646. doi: 10.1200/JCO.2005.12.633
Hershman, D., Weinberg, M., Rosner, Z., Alexis, K., Tiersten, A., Grann, V., … Neugut, A. I. (2003). Ethnic neutropenia and treatment delay in African American women undergoing chemotherapy for early-stage breast cancer. <i>Journal of the National Cancer Institute, 95</i>, 1545-1548. doi: 10.1093/jnci/djg073
Holt, C. L., Clark, E. M., Kreuter, M. W., & Rubio, D. M. (2003). Spiritual health locus of control and breast cancer beliefs among urban African American women. <i>Health Psychology, 22</i>, 294-299. doi: 10.1037/0278-618.104.22.1684
Jemal, A., Siegel, R., Ward, E., Murray, T., Xu, J., & Thun, M. (2007). Cancer statistics, 2007. CA: <i>A Cancer Journal for Clinicians, 57</i>, 43-66. doi: 10.3322/canjclin.57.1.43
Kressin, N. R. (2005). Racial/ethnic disparities in health care: Lessons from medicine for dentistry. <i>Journal of Dental Education, 69</i>, 998-1002.
Lerman, C., & Schwartz, M. (1993). Adherence and psychological adjustment among women at high risk for breast cancer. <i>Breast Cancer Research and Treatment, 28</i>, 145-155.
Lythcott, N., Green, B. L., & Kramer-Brown, Z. (2003). The perspective of African-American breast cancer survivor-advocates. <i>Cancer, 97</i>(1, Suppl.), 324-328. doi: 10.1002/cncr.11013
Magai, C., Consedine, N., Adjei, B., Hershman, D., & Neugut, A. (2008). Psychosocial influences on suboptimal adjuvant breast cancer treatment. <i>Health Education and Behavior, 35</i>, 835-854. doi: 10.1177/1090198107303281
Newman, L. A., Mason, J. Cote, D., Vin, Y., Carolin, K., Bouwman, D., & Colditz, G. A. (2002). African-American ethnicity, socioeconomic status, and breast cancer survival: A meta-analysis of 14 studies involving over 10,000 African-American and 40,000 White American patients with carcinoma of the breast. <i>Cancer, 94</i>, 2844-2854. doi: 10.1002/cncr.10575
Noss, A. (2010). <i>Household income for states: 2008 and 2009.</i> Retrieved from <a target="_blank" href='http://www.census.gov/prod/2010pubs/acsbr09-2.pdf'>http://www.census.gov...
Phillips, J. M., Cohen, M. Z., & Moses, G. (1999). Breast cancer screening and African American women: Fear, fatalism, and silence. <i>Oncology Nursing Forum, 26</i>, 561-571.
Polacek, G. N., Ramos, M. C., & Ferrer, R. L. (2007). Breast cancer disparities and decision-making among U. S. women. <i>Patient Education and Counseling, 65</i>, 158-165. doi: 10.1016/j.pec.2006.06.003
Powe, B. D., Hamilton, J., & Brooks, P. (2006). Perceptions of cancer fatalism and cancer knowledge: A comparison of older and younger African American women. <i>Journal of Psychosocial Oncology, 24</i>, 1-13. doi: 10.1300/J077v24n04_01
Reynolds, P., Boyd, P. T., Blacklow, R. S., Jackson, J. S., Greenberg, R. S., Austin, D. F., … Edwards, B. K. (1994). The relationship between social ties and survival among black and white breast cancer patients. National Cancer Institute Black/White Cancer Survival Study Group. <i>Cancer Epidemiology, Biomarkers and Prevention, 3</i>, 253-259.
Rosenzweig, M., Wiehagen, T., Brufsky, A., & Arnold, R. (2007). Challenges of illness in metastatic breast cancer: A low-income African American perspective. <i>Palliative and Supportive Care, 7</i>, 143-152. doi: 10.1017/S147895150900019
Rosenzweig, M., Weihagen, T., Conroy, B., Sillaman, A., & Arnold, R. (2009). Strengths and challenges of illness in metastatic breast cancer according to race and income. <i>Journal of Hospice and Palliative Nursing, 11</i>, 27-37. doi: 10.1097/NJH.0b013e318191fe6e
Sheppard, V. B., Zambrana, R. E., & O'Malley, A. S. (2004). Providing health care to low-income women: A matter of trust. <i>Family Practice, 21</i>, 484-491. doi: 10.1093/fampra/cmh503
Soler-Vila, H., Kasl, S. V., & Jones, B. A. (2003). Prognostic significance of psychosocial factors in African-American and white breast cancer patients: A population-based study. <i>Cancer, 98</i>, 1299-1308. doi: 10.1002/cncr.11670
Steinberg, M., Fremont, A., Khan, D. C., Huang, D., Knapp, H., Karaman, D., … Streeter, O. E., Jr. (2006). Lay patient navigator program implementation for equal access to cancer care and clinical trials: Essential steps and initial challenges. <i>Cancer, 107</i>, 2669-2677. doi: 10.1002/cncr.22319
Thomas, E. (2006). Ring of silence: African American women's experiences related to their breasts and breast cancer screening. Qualitative Report, 11, 350-373. Retrieved from http://www.nova.edu/ssss/QR/QR11-2/thomas.pdf <a target="_blank" href='http://www.nova.edu/ssss/QR/QR11-2/thomas.pdf'>http://www.nova.edu/ssss/...
University of Pittsburgh, Center on Race and Social Problems. (2007). Pittsburgh's racial demographics: Differences and disparities. Retrieved from <a target="_blank" href='http://www.crsp.pitt.edu/publications/pittsburghdemo.php'>http://www.crs...