AbstractFor women newly diagnosed with breast cancer, psychosocial distress may interfere with their ability to cope with cancer treatment. Nurses should be aware of newly diagnosed breast cancer patient’s concerns and needs during this critical time. The purpose of this study was to identify the needs and concerns of newly diagnosed breast cancer patients. A phone survey of patients was conducted approximately one week post-operatively following breast cancer surgery. Subjects were recruited from 4 hospitals within a large Midwestern healthcare system. A convenience sample of 200 patients was surveyed by breast health nurses involved in their education and support. Subjects were asked to participate in a short survey during the one-week post-operative follow-up phone call. Study results indicate that fear of recurrence, and anxiety regarding post-surgical treatments made up over 2/3 of the responses to the question “What concerns you most about your new diagnosis?” Emotional, social and physical limitations were identified as most important in dealing with a breast cancer diagnosis. As breast health specialists/coordinators, we can improve the quality of care and quality of life for women with breast cancer and their families by providing additional support services and post-treatment information during the initial education and follow-up call.

Identifying the Needs and Concerns of the Newly Diagnosed Breast Cancer Patient

Patrice A. Stephens, MS, RN, AOCN1, Maryjo Osowski, MSN, RN, AOCN2, Mary Sue Fidale, MA, RNC, LCPC3, and Cathy Spagnoli, RN, BS4

1 Advocate Christ Medical Center, Oak Lawn, IL; 2 Westlake Hospital, Melrose Park; 3 Advocate Good Shepherd Hospital, Barrington, Illinois; 4Advocate Medical Group in Park Ridge, Illinois

BackgroundBreast cancer is the most common form of cancer diagnosed in the united states

When faced with a diagnosis, women will experience various feelings of fear, shock, sadness, disbelief or feelings of psychological distress

Most women, with or without psychological support, will cope with their problems and successfully adjust to and manage their disease and survivorship

RESULTS

ConclusionsClinicians can facilitate coping and adjustment to help promote positive patient outcomes for patients diagnosed with breast cancer.

This study demonstrates the need for multiple contacts with a breast nurse for women who are undergoing complex therapies for their disease.

Informational needs of these women can vary.

PurposeTo identify the needs and concerns of the newly diagnosed breast cancer patient

To identify opportunities for improvement in the practice of breast health coordinators / specialists in the Advocate Healthcare System

MethodsIRB approval was obtained. Data collected from November 2004 - January 2006 at the Advocate Sites (Christ Medical Center, Good Samaritan Hospital, Good Shepherd Hospital, Lutheran General Hospital)

225 patients or 20% of the annual population were invited to participate in the study

Newly diagnosed breast cancer patients were contacted approximately one week post-op

Patients answered the open ended questions during the routine post-op telephone call

1.51%3Depression

1.51%3Impact of cancer on finances and loved ones

8.04%16Impact of diagnosis & performance

19.60%39Anxiety regarding the future

30.65%61Anxiety regarding post-surgical treatments

38.69%77Fear of recurrence

%N=199RESPONSES

Table 1: Main Concerns about Diagnosis

Table 2: Needs of Breast Cancer Patients

1.51%3Need for post mastectomy/lumpectomy vendor services

16.08%32Need for post treatment information

19.60%39Need for additional support services

62.81%125No further information needed

%N=199RESPONSES

Table 3: Coping with Breast Cancer Diagnosis

40.70%81More than one of the above factors

8.04%16Spiritual

13.57%27Physical

15.58%31Social

21.61%43Emotional

%N=199RESPONSES

DemographicsSample included 199 patients who completed the interview

Average age of study participants was 62; the range was 23 – 90 years

Racial distribution: Caucasian = 90%, African American = 7%, Hispanic 2%

Surgery for lumpectomy/wide excision = 67% versus mastectomy = 32%

Actions Taken by Breast Health Specialist19% of patients were provided additional information (such as: transportation for radiation therapy, exercise and lymphedema, caregiver and patient support groups, and drug treatments)

17% of patients were provided referrals to the ACS (American Cancer Society)

62% of patients did not require any action

Implications for Nursing

Anxiety was reported by 30% of participants – reinforces need for post-surgical follow-up and assessment of the patient’s anxiety level.

Providing educational resources may help alleviate anxiety for these patients.

The majority of patients were satisfied with the educational materials they initially received, yet improvements are possible.

The learning needs of women living with breast cancer change overtime.

Future Research is Needed

To explore effective interventions aimed at providing knowledge and support to meet the needs of women with breast cancer

To replicate these findings using valid quantitative measures in a large sample.

To explore needs and concerns of specific subgroups such as African American and Hispanic women, as well as those under 45 years of age

Patient survey

Verbal consent to participate in survey obtained: YES NO If verbal consent obtained, proceed with questions below. Question 1: What concerns you most about your new diagnosis? (If asked to clarify, ask them “What is their most important concern right now?) Question 2: What information can I provide or how can I best help you at this time? Question 3: What aspects of breast cancer do you see as most important in dealing with your breast cancer diagnosis, for example, social, physical, emotional, spiritual? Age: __________Type of Surgery: Lumpectomy/Mastectomy Race: __________ SLN/ALND Date of Surgery: _______________ Date of Diagnosis: ______________ Site: Christ Medical Center Good Samaritan Hospital Good Shepherd Hospital Lutheran General Hospital South Suburban Hospital Actions taken, i.e. referrals / info provided: ____________________________________

The authors wish to thank the following people for their support and guidance in this project: Ruth Kleinpell, PhD, RN-CS, FAAN, ACNP, CCRN; Ann Cuvala, RN, MS, OCN; Chris Blair; and Cheryl Lefaiver, PhD, RN