Chemotherapy Adherence Decision Making in Early Stage Breast Cancer Público

Abstract

Abstract
Chemotherapy Adherence Decision Making in Early Stage Breast Cancer

Background: A survival disparity exists between African-American and Caucasian
women with breast cancer. African-American women are more likely to die from breast
cancer than Caucasian women despite having a lower incidence rate. Furthermore,
African-American women are more likely to discontinue chemotherapy early, thus
shortening their survival.
Purpose: The purpose of this study was to examine the variables that influence the
decision to complete or discontinue chemotherapy in African American and Caucasian
women; and, identify racial and contextual differences that may exist in this population.
The Health Decision Model was used to frame the study where the roles of socio-
demographic factors, social interaction factors, the cancer experience, breast cancer
knowledge, and health beliefs were specifically examined to explore differences and
relationships related to treatment decision making.
Sample and Design: The study recruited a convenience sample of 99 African-American
and Caucasian women with early stage breast cancer. The measures and questionnaires
employed for data collection were: Demographics Measure, Norbeck's Social Support
Questionnaire, the Pargament Religious Coping Scale, the Comprehensive Breast Cancer
Related Knowledge Scale, Memorial Symptom Assessment Scale Short Form, the Powe
Fatalism Inventory, Center for Epidemiologic Studies- Depression and the Champion
Health Belief Model Scale. The variable, days from diagnosis to treatment, was added as
a proxy to adherence to treatment recommendations. Data analyses included univariate
and bivariate analyses, multiple hierarchical regressions, and logistic regressions.
Results: Race was closely associated with many of the study's contextual factors.
Additionally, education was found to be a significant predictor to many of the
relationships explored within the model. Due to a largely adherent sample, predictors
and differences to non-adherence could not be assessed. However, other findings
revealed breast cancer knowledge and cancer fatalism predicted days from diagnosis to
treatment.
Discussion: Knowledge and fatalistic views toward breast cancer were important
predictors to the decision to start treatment. The predictors related to days from diagnosis
to treatment have several clinical and policy-related implications. More research is
needed in this area and to guide future intervention studies.

Table of Contents

Chapter

I. INTRODUCTION

Statement of the problem ………………………………………………….… 1

Purpose ...………………………………………………………………….…. 4

Specific Aims ……………………………………………………………..…. 5

Conceptual Framework …………………………………………………........ 6

Overview of the Health Decision Model ………………………............... 6

Key Concepts and Propositions of the Health Decision Model ….....…… 7

Summary ……………………………………………………..………… 11

Relevance of the Proposed Study ………………………………………...... 12

Summary ……………………………………………………………….…... 13

II. BACKGROUND AND SIGNIFICANCE

Defining Treatment Adherence …………………………………………….. 15

The Impact of Treatment Non-adherence ………………………………….. 17

Adherence to Intravenous Chemotherapy ………………………………….. 19

Racial Differences in Chemotherapy Adherence ………………………. 20

Contextual Factors Related to Adherence ………………………………….. 21

Socio-demographic Factors ……………………………………………. 21

Social Interaction …………………………………………………..…... 27

Breast Cancer Knowledge ……………………………………………… 32

Cancer Experience ……………………………………………………... 33

Cancer-Specific Health Beliefs ………………………………………… 37

Summary 39

III. BREAST CANCER: A FEMINIST PERSPECTIVE

History of Women's Health ………………………………………………... 40

Modern Medicine and Women …………………………………………….. 42

The Construction of Breast Cancer ………………………………………… 44

The Other Body: Analysis of Black Women's Bodies …………………….. 50

The Other Breasts: Breast Cancer and Black Women ……………………... 52

Women's Bodies and Healthcare …………………………………………... 53

Summary …………………………………………………………………… 57

IV. RESEARCH DESIGN AND METHODOLOGY

Overview of the Study ……………………………………………………... 59

Research Design ………………………………………...………………..... 59

Power Analysis and Sample Size Calculation ……………………………... 60

Research Sample and Setting ……….……………………………………… 61

Recruitment of the Sample ………………………………………………… 65

Sample Inclusion/Exclusion Criteria …………………………………... 65

Rationales for the Selected Population ………………………………… 65

Recruitment Strategy …………………………………………………... 66

Methodology ……………………………………………………………….. 67

Operational Definitions ………………………………………………… 67

Measurement Instruments ……………………………………………… 72

Data Collection and Procedures ………………………………………... 79

Protection of Human Subjects …………………………………………. 81

Potential Risks and Benefits …………………………………… 83

Data Analysis …………………………………………………………... 84

Other Findings …………………………..……………………... 87

Limitations ……………………………………………………………... 87

Summary …………………………………………………………………… 88

V. RESULTS

Aim 1 ………………………………………………………………………. 90

Research Question 1 …………………………………………………… 90

Socio-demographic Factors and Breast Cancer Knowledge …… 90

Socio-demographic Factors and Social Interaction ……………. 95

Socio-demographic Factors and Cancer Experience …………... 98

Social Interaction and Cancer Experience ……………………. 100

Social Interaction and Breast Cancer Knowledge ……………. 101

Breast Cancer Knowledge and Cancer Experience …………... 104

Research Question 2 ………………………………………………….. 105

Aim 2 ……………………………………………………………………... 118

Research Question 3 ………………………………………………….. 118

Research Question 4 ………………………………………………….. 118

Other Findings ……………...…………………………………………….. 119

Summary ………………………………………………………………….. 123

VI. DISCUSSION AND CONCLUSIONS

Summary of Findings …………………………………………………….. 124

Research Question 1 ………………………………………………….. 124

Research Question 2 ………………………………………………….. 125

Research Question 3 ………………………………………………….. 126

Research Question 4 ………………………………………………….. 126

Other Findings ……………………………………………………...… 126

Discussion of Findings ……………………………………………………. 126

Noteworthy Relationships …………………………………………….. 128

Feminist Perspective of Findings ……………………………………... 132

Study Conclusions ………………………………………………………... 133

Implications for Clinical Practice …………………………………….. 134

Implications for Research …………………………………………….. 135

Implications for Policy ………………………………………………... 136

Strengths of the Study ………………………………………………… 137

Limitations of the Study ………………………………………………. 138

Summary ………………………………………………………………….. 139

References …………………………………………………………………….. 140

Appendix A: Descriptive Differences between African-American and Caucasian Women ............................................................................................................... 160

Appendix B: Demographic Questionnaire ……………………………….…… 162

Appendix C: Consent to be a Research Subject Form ……………………...… 165

Appendix D: The HIPPA Form …………………………………………......... 169

About this Dissertation

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School	Laney Graduate School
Department	Nursing
Degree	PhD
Submission	Dissertation
Language	English
Research Field	Health Sciences, Nursing
Palavra-chave	Breast cancer Chemotherapy Decision-making Adherence
Committee Chair / Thesis Advisor	Strickland, Ora, Florida International University
Committee Members	Freeman, Sarah B, Emory University Roy, Deboleena, Emory University Dalton, Jo Ann, Emory University

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