TY - JOUR ID - 126206446 T1 - Tailoring exercise interventions to comorbidities and treatment-induced adverse effects in patients with early stage breast cancer undergoing chemotherapy: a framework to support clinical decisions. AU - van der Leeden, Marike AU - Huijsmans, Rosalie J. AU - Geleijn, Edwin AU - de Rooij, Mariëtte AU - Konings, Inge R. AU - Buffart, Laurien M. AU - Dekker, Joost AU - Stuiver, Martijn M. Y1 - 2018/02/15/ N1 - Accession Number: 126206446. Language: English. Entry Date: 20171116. Revision Date: 20171116. Publication Type: Article; algorithm; tables/charts. Journal Subset: Allied Health; Europe; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care; Women's Health. NLM UID: 9207179. KW - Therapeutic Exercise KW - Breast Neoplasms KW - Cancer Patients KW - Chemotherapy, Cancer -- Adverse Effects KW - Decision Making, Clinical KW - Comorbidity KW - Practice Guidelines KW - Algorithms SP - 486 EP - 496 JO - Disability & Rehabilitation JF - Disability & Rehabilitation JA - DISABIL REHABIL VL - 40 IS - 4 CY - Philadelphia, Pennsylvania PB - Taylor & Francis Ltd AB - Purpose:Delivery of exercise interventions to patients with early-stage breast cancer undergoing chemotherapy requires complex clinical decisions. The purpose of this study was to develop a framework to support clinical decisions for tailoring exercise interventions to common comorbidities and cancer treatment-induced adverse effects. Method:Tailored exercise prescriptions were developed in four steps, following the i3-S strategy. All steps were based on current best available evidence, complemented with expert opinions. First, common comorbidities and treatment-induced adverse effects were identified. In the subsequent steps, contra-indications and restrictions for exercise were described, along with possible exercise adaptations. In the final step, the obtained information was synthesized into a framework. Results:Prevalent comorbidities were hypertension, heart disease, diabetes mellitus, (osteo)arthritis, chronic obstructive pulmonary disease, and obesity. Adverse effects included conditions induced by pretreatment (e.g., lymphedema as a result of surgery) or by chemotherapy (e.g., reduced blood cell counts). Adaptations to the recommended exercise program were related to exercise tolerance, safety, and hygiene. A framework was proposed to guide clinical decisions during the exercise intervention. Conclusion:Comorbidities and adverse effects of breast cancer treatment require exercise adaptations. The proposed framework provides guidance on tailored exercise prescriptions in patients with breast cancer undergoing chemotherapy.Implications for RehabilitationExercise is recommended for patients with breast cancer undergoing chemotherapy, but requires complex clinical decisions of the health professional.We identified the most important comorbidities and adverse effects of breast cancer treatment, and the resultant contra-indications and restrictions to exercise.We incorporated these findings into a clinical decision framework that provides suggestions for exercise adaptations in patients with breast cancer undergoing chemotherapy. SN - 0963-8288 AD - Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands; AD - Reade, Amsterdam Rehabilitation Research Centre, Amsterdam, The Netherlands; AD - Department of Medical Oncology, VU University Medical Center-Cancer Center Amsterdam, Amsterdam, The Netherlands; AD - Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands; AD - Department of Physiotherapy, Netherlands Cancer Institute, Amsterdam, The Netherlands DO - 10.1080/09638288.2016.1260647 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=126206446&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 126986398 T1 - Oral Endocrine Therapy Nonadherence, Adverse Effects, Decisional Support, and Decisional Needs in Women With Breast Cancer. AU - Milata, Jennifer L. AU - Otte, Julie L. AU - Carpenter, Janet S. Y1 - 2018/01// N1 - Accession Number: 126986398. Language: English. Entry Date: In Process. Revision Date: 20171229. Publication Type: Article. Journal Subset: Core Nursing; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Nursing; Peer Reviewed; USA. NLM UID: 7805358. SP - E9 EP - E18 JO - Cancer Nursing JF - Cancer Nursing JA - CANCER NURS VL - 41 IS - 1 CY - Baltimore, Maryland PB - Lippincott Williams & Wilkins AB - Background: Oral endocrine therapy (OET) such as tamoxifen or aromatase inhibitors reduces recurrence and mortality for the 75% of breast cancer survivors (BCSs) with a diagnosis of estrogen receptorYpositive breast cancer. Because many BCSs decide not take OET as recommended because of adverse effects, understanding BCSs' decisional supports and needs is foundational to supporting quality OET decision making about whether to adhere to OET. Objective: The aim of this study was to examine literature pertaining to OET nonadherence and adverse effects using the Ottawa Decision Support Framework categories of decisional supports and decisional needs because these factors potentially influence OET use. Methods: A systematic literature search was performed in PubMed and CINAHL using combined search terms "aromatase inhibitors and adherence" and "tamoxifen and adherence." Studies that did not meet criteria were excluded. Relevant data from 25 publications were extracted into tables and reviewed by 2 authors. Results: Findings identified the impact of adverse effects on OET nonadherence, an absence of decisional supports provided to or available for BCSs who are experiencing OET adverse effects, and the likelihood of unmet decisional needs related to OET. Conclusions: Adverse effects contribute to BCSs decisions to stop OET, yet there has been little investigation of the process through which that occurs. This review serves as a call to action for providers to provide support to BCSs experiencing OET adverse effects and facing decisions related to nonadherence. Implications for Practice: Findings suggest BCSs prescribed OET have unmet decisional needs, and more decisional supports are needed for BCSs experiencing OET adverse effects. SN - 0162-220X AD - Department of Science of Nursing Care, Indiana University School of Nursing, Indianapolis DO - 10.1097/NCC.0000000000000430 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=126986398&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 125429005 T1 - African American Women's Perspectives on Donating Healthy Breast Tissue for Research: Implications for Recruitment. AU - Ridley-Merriweather, Katherine E. AU - Head, Katharine J. Y1 - 2017/12// N1 - Accession Number: 125429005. Language: English. Entry Date: 20171004. Revision Date: 20171009. Publication Type: Article; research; tables/charts. Journal Subset: Blind Peer Reviewed; Health Promotion/Education; Peer Reviewed; USA. Special Interest: Oncologic Care; Women's Health. NLM UID: 8908762. KW - Blacks KW - Consumer Attitudes KW - Breast Neoplasms -- Prevention and Control KW - Living Donors KW - Human KW - Female KW - Models, Theoretical KW - Questionnaires KW - World Wide Web KW - Race Factors KW - Research, Medical KW - Data Analysis Software KW - Coding KW - Constant Comparative Method KW - Qualitative Studies KW - Thematic Analysis KW - Accountability SP - 1571 EP - 1580 JO - Health Communication JF - Health Communication JA - HEALTH COMMUN VL - 32 IS - 12 CY - Philadelphia, Pennsylvania PB - Taylor & Francis Ltd AB - African American women die of breast cancer at a higher rate than any other racial group. The Komen Tissue Bank (KTB) is an ongoing clinical trial that collects healthy breast tissue from women of all racial groups to use as controls in research and represents a critical tool in efforts to treat and prevent breast cancer; however, African Americans display reticence toward donating breast tissue to the KTB. Through the lens of the Integrated Behavioral Model, this study recruited African American women to share their perspectives on donating breast tissue for research purposes. Seventy-one (N = 71) eligible Black women who were previous tissue donors to the KTB responded to an online questionnaire. Findings revealed that (a) participants had positive instrumental attitudes or reasons for donating; (b) participants felt generally supported in their decision to donate, but revealed that the lack of Black women participating in the KTB meant that they themselves were setting the norm for others; and (c) their race was an important element in their donation decision. While acknowledging the negative history of African Americans in medical research, they offered their perceptions regarding the importance of involving themselves in medical research, and suggested that health communication strategies to recruit African Americans into research should embrace race as part of the message. The findings from this study have important implications for other those who work in applied clinical settings and are interested in addressing racial disparities in medical research through more effective and targeted recruitment messaging. SN - 1041-0236 AD - Susan G. Komen® Tissue Bank at the IU Simon Cancer Center (Indianapolis) AD - Department of Communication Studies, Indiana University-Purdue University Indianapolis DO - 10.1080/10410236.2016.1250191 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=125429005&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 126056150 T1 - The Perceptions and Expectations of Older Women in the Establishment of the Senior Women's Breast Cancer Clinic (SWBCC): a Needs Assessment Study. AU - Tjong, Michael AU - Menjak, Ines AU - Trudeau, Maureen AU - Mehta, Rajin AU - Wright, Frances AU - Leahey, Angela AU - Ellis, Janet AU - Gallagher, Damian AU - Gibson, Leslie AU - Bristow, Bonnie AU - Rice, Katie AU - Szumacher, Ewa AU - Tjong, Michael C Y1 - 2017/12// N1 - Accession Number: 126056150. Language: English. Entry Date: In Process. Revision Date: 20171115. Publication Type: journal article. Journal Subset: Biomedical; Blind Peer Reviewed; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Health Promotion/Education; Peer Reviewed; USA. NLM UID: 8610343. SP - 850 EP - 857 JO - Journal of Cancer Education JF - Journal of Cancer Education JA - J CANCER EDUC VL - 32 IS - 4 CY - , PB - Springer Science & Business Media B.V. AB - This study explored older women's perceptions and expectations of the prospective Senior Women's Breast Cancer Clinic (SWBCC) at Sunnybrook Odette Cancer Centre (SOCC) in Toronto, Ontario, Canada. In our previous studies, older breast cancer patients had expressed a greater need for informational, decisional, and post-treatment support. This study also assessed women's perspectives on the involvement of geriatricians and incorporation of geriatric assessment in their cancer care. Twelve breast cancer patients aged 68 years or older who were treated at the SOCC participated in the study. We recorded and transcribed 11 interviews and analyzed them using qualitative thematic analysis methods to identify major themes; one interview was excluded due to recording defect. Eight major themes were identified: transportation issues, service, communication between patient and healthcare professionals, communication between healthcare professionals, support during treatment, support after treatment, informational resources, and patient suggestions. Important issues were raised by participants, such as difficulties in arranging transportation to the clinic, barriers in accessing family physician service, and communication breakdown that result in treatment delay and unaddressed complications. In conclusion, there were important gaps in the cancer care of older women with breast cancer that could be detected earlier and better addressed in the new multidisciplinary SWBCC. The participating women were highly supportive of the initiative and made several suggestions on how the clinic could better accommodate their specific needs during and after breast cancer treatment. SN - 0885-8195 AD - Faculty of Medicine , University of Toronto , Toronto Canada AD - Odette Cancer Centre , Sunnybrook Health Sciences Centre , Toronto Canada AD - Faculty of Medicine, University of Toronto, Toronto, ON, Canada U2 - PMID: 27142360. DO - 10.1007/s13187-016-1042-1 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=126056150&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 126075025 T1 - 'It was an Emotional Baby': Previvors' Family Planning Decision-Making Styles about Hereditary Breast and Ovarian Cancer Risk. AU - Dean, Marleah AU - Rauscher, Emily Y1 - 2017/12// N1 - Accession Number: 126075025. Language: English. Entry Date: 20171118. Revision Date: 20171118. Publication Type: Article; questionnaire/scale; research; tables/charts. Journal Subset: Biomedical; Continental Europe; Europe; Peer Reviewed. NLM UID: 9206865. KW - Hereditary Breast and Ovarian Cancer Syndrome -- Risk Factors KW - Hereditary Breast and Ovarian Cancer Syndrome -- Psychosocial Factors KW - Family Planning -- Psychosocial Factors KW - Decision Making -- Methods KW - Genes, BRCA KW - Human KW - Female KW - Interviews KW - Emotions KW - Logic KW - Fear KW - Quality of Life KW - Genetic Screening KW - Qualitative Studies KW - Young Adult KW - Adult KW - Middle Age KW - Interview Guides SP - 1301 EP - 1313 JO - Journal of Genetic Counseling JF - Journal of Genetic Counseling JA - J GENETIC COUNS VL - 26 IS - 6 CY - , PB - Springer Science & Business Media B.V. AB - Women who test positive for a BRCA genetic mutation are at an increased risk for developing hereditary breast and ovarian cancer and have a 50% chance of passing on their genetic mutation to their children. The purpose of this study was to investigate how women who test positive for a BRCA mutation but have not been diagnosed with cancer make decisions regarding family planning. Analysis of interviews with 20 women revealed they engage in logical and emotional decision-making styles. Although women want to be logical to reduce their hereditary cancer risk, emotions often complicate their decision-making. Women experience fear and worry about a future cancer diagnosis, yet also desire to create a family, particularly having children through natural conception. That is, women negotiate having preventative surgeries in a logical doctor-recommended timeframe but also organize those decisions around emotional desires of motherhood. Overall, this study demonstrates the complex decisions women who test positive for a BRCA mutation must make in regards to genetic testing timing, family planning, and overall quality of life. SN - 1059-7700 AD - Department of Communication , The University of South Florida , 4202 E Fowler Ave CIS 3057 Tampa 33620 USA AD - Department of Communication , Texas A&M University , College Station USA DO - 10.1007/s10897-017-0069-8 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=126075025&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 126162038 T1 - Flat Epithelial Atypia: Upgrade Rates and Risk-Stratification Approach to Support Informed Decision Making. AU - Lamb, Leslie R. AU - Bahl, Manisha AU - Gadd, Michele A. AU - Lehman, Constance D. Y1 - 2017/12// N1 - Accession Number: 126162038. Language: English. Entry Date: 20171222. Revision Date: 20171222. Publication Type: journal article. Journal Subset: Biomedical; USA. Instrumentation: Craig Handicap Assessment and Reporting Technique (CHART); Personal Resource Questionnaire (PRQ). NLM UID: 9431305. KW - Breast -- Pathology KW - Carcinoma in Situ -- Pathology KW - Breast Neoplasms -- Pathology KW - Middle Age KW - Female KW - Adult KW - Retrospective Design KW - Aged, 80 and Over KW - Risk Assessment KW - Aged KW - Neoplasm Grading -- Statistics and Numerical Data KW - Personal Resource Questionnaire SP - 696 EP - 701 JO - Journal of the American College of Surgeons JF - Journal of the American College of Surgeons JA - J AM COLL SURG VL - 225 IS - 6 CY - New York, New York PB - Elsevier B.V. AB - Background: Our aim was to determine upgrade rates of pure flat epithelial atypia (FEA) to malignancy and higher-risk lesions and to identify patients with FEA at low risk for upgrade.Study Design: Medical chart review from 2007 to 2016 identified 208 consecutive patients with pure FEA diagnosed by image-guided core needle biopsy who underwent surgical excision (96.2% [200 of 208]) or had at least 2 years of imaging follow-up (3.8% [8 of 208]). Medical records were reviewed for risk factors and surgical outcomes.Results: Overall upgrade rate of FEA to malignancy was 2.4% (5 of 208). All 5 upgraded cases were ductal carcinoma in situ at operation. The upgrade rate to atypical ductal hyperplasia, lobular carcinoma in situ, or atypical lobular hyperplasia was 29.8% (62 of 208). The FEA lesions in patients with a genetic mutation were more likely to upgrade to malignancy than FEA lesions in patients without a genetic mutation (33.3% [1 of 3] vs 2.0% [4 of 205]; p < 0.01). The FEA lesions in patients with a personal history of breast cancer were more likely to upgrade to higher-risk lesions than those without a personal history (47.8% [11 of 23] vs 27.6% [51 of 185]; p = 0.046) but were not more likely to be upgraded to malignancy (0% [0 of 23] vs 2.7% [5 of 185]; p = 0.42).Conclusions: The overall risk of upgrade of FEA to malignancy is low at 2.4%; however, the upgrade rate to a higher-risk lesion is nearly 30%. Surveillance rather than surgical excision of FEA can be a reasonable option for patients without a genetic mutation who opt against chemoprevention. SN - 1072-7515 AD - Department of Radiology, Massachusetts General Hospital, Boston, MA AD - Department of Surgery, Massachusetts General Hospital, Boston, MA U2 - PMID: 29100673. DO - 10.1016/j.jamcollsurg.2017.08.022 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=126162038&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 126279389 T1 - The menopausal woman: The need for an individualized plan of care. AU - Todd Pace, Diane Y1 - 2017/12// N1 - Accession Number: 126279389. Language: English. Entry Date: 20171129. Revision Date: 20171129. Publication Type: Article; pictorial; review; tables/charts. Journal Subset: Core Nursing; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Nursing; Peer Reviewed; USA. Special Interest: Advanced Nursing Practice; Women's Health. NLM UID: 7603663. KW - Perimenopause -- Physiology KW - Perimenopausal Symptoms -- Diagnosis KW - Perimenopausal Symptoms -- Therapy KW - Gynecologic Care KW - Women's Health KW - Decision Making, Clinical KW - Perimenopausal Symptoms -- Physiopathology KW - Perimenopausal Symptoms -- Risk Factors KW - Perimenopausal Symptoms -- Epidemiology KW - Perimenopausal Symptoms -- Drug Therapy KW - Vagina -- Pathology KW - Alternative Therapies KW - Dietary Supplements KW - Hormone Replacement Therapy KW - Estrogens -- Administration and Dosage KW - Estrogens -- Adverse Effects KW - Progesterone -- Administration and Dosage KW - Progesterone -- Adverse Effects KW - Dosage Forms KW - Endometrial Neoplasms -- Prevention and Control KW - Practice Guidelines KW - Treatment Duration KW - Female KW - Adult KW - Middle Age KW - Aged KW - Patient Education KW - Breast Neoplasms -- Risk Factors KW - Venous Thromboembolism -- Risk Factors KW - Drug Compounding KW - Pharmacy, Retail KW - Estrogens -- Contraindications KW - Progesterone -- Contraindications KW - Risk Assessment KW - Mobile Applications KW - Decision Support Techniques SP - 43 EP - 49 JO - Nurse Practitioner JF - Nurse Practitioner JA - NURSE PRACT VL - 42 IS - 12 CY - Baltimore, Maryland PB - Lippincott Williams & Wilkins AB - With life expectancy increasing, women will spend one-third of their lives in and beyond menopause. A collaborative discussion with the clinician facilitates informed decision-making and should include evidence-based discussion of physiologic changes, assessment of symptoms and treatment options, review of screening recommendations, and discussion of disease risk-reduction strategies and psychosocial issues. SN - 0361-1817 AD - Associate professor/director of special academic programs at the University of Tennessee Health Science Center, College of Nursing, Memphis, Tenn. DO - 10.1097/01.NPR.0000526765.60971.37 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=126279389&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 125921871 T1 - Cost-effectiveness of population based BRCA testing with varying Ashkenazi Jewish ancestry. AU - Manchanda, Ranjit AU - Patel, Shreeya AU - Antoniou, Antonis C. AU - Levy-Lahad, Ephrat AU - Turnbull, Clare AU - Evans, D. Gareth AU - Hopper, John L. AU - Macinnis, Robert J. AU - Menon, Usha AU - Jacobs, Ian AU - Legood, Rosa Y1 - 2017/11// N1 - Accession Number: 125921871. Language: English. Entry Date: 20171129. Revision Date: 20171208. Publication Type: journal article. Journal Subset: Biomedical; Peer Reviewed; USA. Instrumentation: General Health Questionnaire (GHQ); Longitudinal Interval Follow-Up Evaluation (LIFE); Ferrans and Powers Quality of Life Index. NLM UID: 0370476. KW - Genetic Screening -- Economics KW - Jews KW - Genes, BRCA KW - Health Care Costs KW - Quality-Adjusted Life Years KW - Hereditary Breast and Ovarian Cancer Syndrome -- Diagnosis KW - Adult KW - Salpingectomy -- Economics KW - Oophorectomy -- Economics KW - Cost Benefit Analysis KW - United States KW - Female KW - Decision Support Techniques KW - Patient History Taking KW - Hereditary Breast and Ovarian Cancer Syndrome -- Economics KW - Genetic Screening -- Methods KW - Hereditary Breast and Ovarian Cancer Syndrome KW - Ferrans and Powers Quality of Life Index KW - Questionnaires SP - 578.e1 EP - 578.e12 JO - American Journal of Obstetrics & Gynecology JF - American Journal of Obstetrics & Gynecology JA - AM J OBSTET GYNECOL VL - 217 IS - 5 CY - New York, New York PB - Elsevier B.V. AB - Background: Population-based BRCA1/BRCA2 testing has been found to be cost-effective compared with family history-based testing in Ashkenazi-Jewish women were >30 years old with 4 Ashkenazi-Jewish grandparents. However, individuals may have 1, 2, or 3 Ashkenazi-Jewish grandparents, and cost-effectiveness data are lacking at these lower BRCA prevalence estimates. We present an updated cost-effectiveness analysis of population BRCA1/BRCA2 testing for women with 1, 2, and 3 Ashkenazi-Jewish grandparents.Study Design: Decision analysis model.Methods: Lifetime costs and effects of population and family history-based testing were compared with the use of a decision analysis model. 56% BRCA carriers are missed by family history criteria alone. Analyses were conducted for United Kingdom and United States populations. Model parameters were obtained from the Genetic Cancer Prediction through Population Screening trial and published literature. Model parameters and BRCA population prevalence for individuals with 3, 2, or 1 Ashkenazi-Jewish grandparent were adjusted for the relative frequency of BRCA mutations in the Ashkenazi-Jewish and general populations. Incremental cost-effectiveness ratios were calculated for all Ashkenazi-Jewish grandparent scenarios. Costs, along with outcomes, were discounted at 3.5%. The time horizon of the analysis is "life-time," and perspective is "payer." Probabilistic sensitivity analysis evaluated model uncertainty.Results: Population testing for BRCA mutations is cost-saving in Ashkenazi-Jewish women with 2, 3, or 4 grandparents (22-33 days life-gained) in the United Kingdom and 1, 2, 3, or 4 grandparents (12-26 days life-gained) in the United States populations, respectively. It is also extremely cost-effective in women in the United Kingdom with just 1 Ashkenazi-Jewish grandparent with an incremental cost-effectiveness ratio of £863 per quality-adjusted life-years and 15 days life gained. Results show that population-testing remains cost-effective at the £20,000-30000 per quality-adjusted life-years and $100,000 per quality-adjusted life-years willingness-to-pay thresholds for all 4 Ashkenazi-Jewish grandparent scenarios, with ≥95% simulations found to be cost-effective on probabilistic sensitivity analysis. Population-testing remains cost-effective in the absence of reduction in breast cancer risk from oophorectomy and at lower risk-reducing mastectomy (13%) or risk-reducing salpingo-oophorectomy (20%) rates.Conclusion: Population testing for BRCA mutations with varying levels of Ashkenazi-Jewish ancestry is cost-effective in the United Kingdom and the United States. These results support population testing in Ashkenazi-Jewish women with 1-4 Ashkenazi-Jewish grandparent ancestry. SN - 0002-9378 AD - Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London, UK AD - Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, London, UK AD - Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women’s Health, University College London, London, UK AD - Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK AD - Centre for Cancer Genetic Epidemiology, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge, UK AD - Medical Genetics Institute, Shaare Zedek Hospital, Jerusalem, Israel AD - Barts Cancer Institute, Queen Mary University of London, London, UK AD - Centre for Genomic Medicine, Division of Evolution and Genomic science, University of Manchester, Manchester, UK AD - Centre for Epidemiology & Biostatistics, Melbourne School of Population & Global Health, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Victoria, Australia AD - Cancer Epidemiology & Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia AD - University of New South Wales, UNSW Sydney NSW U2 - PMID: 28690137. DO - 10.1016/j.ajog.2017.06.038 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=125921871&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 125461680 T1 - Decision-support networks of women newly diagnosed with breast cancer. AU - Wallner, Lauren P. AU - Li, Yun AU - McLeod, M. Chandler AU - Hamilton, Ann S. AU - Ward, Kevin C. AU - Veenstra, Christine M. AU - An, Lawrence C. AU - Janz, Nancy K. AU - Katz, Steven J. AU - Hawley, Sarah T. Y1 - 2017/10/15/ N1 - Accession Number: 125461680. Language: English. Entry Date: 20171021. Revision Date: 20171231. Publication Type: journal article. Journal Subset: Biomedical; Peer Reviewed; USA. Grant Information: HHSN261201000035I/CA/NCI NIH HHS/United States. NLM UID: 0374236. KW - Breast Neoplasms -- Therapy KW - Decision Making KW - Support, Psychosocial KW - Age Factors KW - Registries, Disease KW - Marital Status KW - California KW - Aged KW - Blacks KW - Linear Regression KW - Adult KW - Middle Age KW - Female KW - Georgia KW - Multivariate Analysis SP - 3895 EP - 3903 JO - Cancer (0008543X) JF - Cancer (0008543X) JA - CANCER VL - 123 IS - 20 CY - Hoboken, New Jersey PB - John Wiley & Sons, Inc. AB - Background: Little is known about the size and characteristics of the decision-support networks of women newly diagnosed with breast cancer and whether their involvement improves breast cancer treatment decisions.Methods: A population-based sample of patients newly diagnosed with breast cancer in 2014 and 2015, as reported to the Georgia and Los Angeles Surveillance, Epidemiology, and End Results registries, were surveyed approximately 7 months after diagnosis (N = 2502; response rate, 68%). Network size was estimated by asking women to list up to 3 of the most important decision-support persons (DSPs) who helped them with locoregional therapy decisions. Decision deliberation was measured using 4 items assessing the degree to which patients thought through the decision, with higher scores reflecting more deliberative breast cancer treatment decisions. The size of the network (range, 0-3 or more) was compared across patient-level characteristics, and adjusted mean deliberation scores were estimated across levels of network size using multivariable linear regression.Results: Of the 2502 women included in this analysis, 51% reported having 3 or more DSPs, 20% reported 2, 18% reported 1, and 11% reported not having any DSPs. Married/partnered women, those younger than 45 years, and black women all were more likely to report larger network sizes (all P < .001). Larger support networks were associated with more deliberative surgical treatment decisions (P < .001).Conclusions: Most women engaged multiple DSPs in their treatment decision making, and involving more DSPs was associated with more deliberative treatment decisions. Future initiatives to improve treatment decision making among women with breast cancer should acknowledge and engage informal DSPs. Cancer 2017;123:3895-903. © 2017 American Cancer Society. SN - 0008-543X AD - Department of Internal Medicine, University of Michigan AD - Department of Epidemiology, University of Michigan AD - Department of Biostatistics, University of Michigan AD - Department of Preventive Medicine, University of Southern California Keck School of Medicine AD - Department of Epidemiology, Emory University AD - Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan AD - Department of Health Behavior and Health Education, University of Michigan AD - Department of Health Management and Policy, University of Michigan AD - Ann Arbor Veterans Affairs Center for Clinical Management Research U2 - PMID: 28640360. DO - 10.1002/cncr.30848 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=125461680&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 125443465 T1 - A study protocol of the effectiveness of PEGASUS: a multi-centred study comparing an intervention to promote shared decision making about breast reconstruction with treatment as usual. AU - Harcourt, Diana AU - Paraskeva, Nicole AU - White, Paul AU - Powell, Jane AU - Clarke, Alex Y1 - 2017/10/02/ N1 - Accession Number: 125443465. Language: English. Entry Date: In Process. Revision Date: 20171021. Publication Type: journal article. Journal Subset: Biomedical; Computer/Information Science; Europe; UK & Ireland. NLM UID: 101088682. SP - 1 EP - 7 JO - BMC Medical Informatics & Decision Making JF - BMC Medical Informatics & Decision Making JA - BMC MED INFORM DECIS MAKING VL - 17 PB - BioMed Central AB - Background: Increasingly, women elect breast reconstruction after mastectomy. However, their expectations of surgery are often not met, and dissatisfaction with outcome and ongoing psychosocial concerns and distress are common. We developed a patient-centered intervention, PEGASUS:(Patients' Expectations and Goals: Assisting Shared Understanding of Surgery) which supports shared decision making by helping women clarify their own, individual goals about reconstruction so that they can discuss these with their surgeon. Our acceptability/feasibility work has shown it is well received by patients and health professionals alike. We now need to establish whether PEGASUS improves patients' experiences of breast reconstruction decision making and outcomes. The purpose of this study is, therefore, to examine the effectiveness of PEGASUS, an intervention designed to support shared decision making about breast reconstruction.Methods: A multi-centered sequential study will compare the impact of PEGASUS with usual care, in terms of patient reported outcomes (self-reported satisfaction with the outcome of surgery, involvement in decision making and in the consultation) and health economics. Initially we will collect data from our comparison (usual care) group (90 women) who will complete standardized measures (Breast-Q, EQ5D -5 L and ICECAP- A) at the time of decision making, 3, 6 and 12 months after surgery. Health professionals will then be trained to use PEGASUS, which will be delivered to the intervention group (another 90 women completing the same measures at the time of decision making, and 3, 6 and 12 months after surgery). Health professionals and a purposefully selected sample of participants will be interviewed about whether their expectations of reconstruction were met, and their experiences of PEGASUS (if appropriate).Discussion: PEGASUS may have the potential to provide health professionals with an easily accessible tool aiming to support shared decision making and improve patients' satisfaction with breast reconstruction. Results of this study will be available at the end of 2019.Trial Registration: ISRCTN 18000391 (DOI 10.1186/ISRCTN18000391) 27/01/2016. SN - 1472-6947 AD - Department of Health & Social Sciences, Centre for Appearance Research, Faculty of Health & Applied Sciences University of the West of England, Coldharbour Lane, Bristol BS16 1QY, UK. AD - Department of Engineering Design & Mathematics, Faculty of Environment & Technology, University of the West of England, Bristol BS16 1QY, UK. AD - Public Health and Well Being Research Group, Department of Health & Social Sciences, Faculty of Health & Applied Sciences University of the West of England, Bristol BS16 1QY, UK. U2 - PMID: 28969622. DO - 10.1186/s12911-017-0543-0 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=125443465&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 125833844 T1 - Reducing Racial Disparities in Breast Cancer Care: The Role of 'Big Data'. AU - Reeder-Hayes, Katherine E. AU - Troester, Melissa A. AU - Meyer, Anne-Marie Y1 - 2017/10// N1 - Accession Number: 125833844. Language: English. Entry Date: 20171026. Revision Date: 20171026. Publication Type: Article; pictorial; review; tables/charts. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Oncologic Care. NLM UID: 8712059. KW - Race Factors KW - Breast Neoplasms KW - Data Analytics KW - Healthcare Disparities KW - Models, Structural SP - 756 EP - 762 JO - Oncology (08909091) JF - Oncology (08909091) JA - ONCOLOGY (08909091) VL - 31 IS - 10 CY - Norwalk, Connecticut PB - UBM Medica AB - Advances in a wide array of scientific technologies have brought data of unprecedented volume and complexity into the oncology research space. These novel big data resources are applied across a variety of contexts--from health services research using data from insurance claims, cancer registries, and electronic health records, to deeper and broader genomic characterizations of disease. Several forms of big data show promise for improving our understanding of racial disparities in breast cancer, and for powering more intelligent and far-reaching interventions to close the racial gap in breast cancer survival. In this article we introduce several major types of big data used in breast cancer disparities research, highlight important findings to date, and discuss how big data may transform breast cancer disparities research in ways that lead to meaningful, lifesaving changes in breast cancer screening and treatment. We also discuss key challenges that may hinder progress in using big data for cancer disparities research and quality improvement. SN - 0890-9091 AD - Assistant Professor, Division of Hematology and Oncology, Department of Medicine, University of North Carolina at Chapel Hill AD - University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina AD - Professor, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill AD - Assistant Professor, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=125833844&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 125592369 T1 - Qualitatively understanding patients' and health professionals' experiences of the BRECONDA breast reconstruction decision aid. AU - Sherman, Kerry A. AU - Shaw, Laura-Kate AU - Jørgensen, Lone AU - Harcourt, Diana AU - Cameron, Linda AU - Boyages, John AU - Elder, Elisabeth AU - Kirk, Judy AU - Tucker, Katherine Y1 - 2017/10// N1 - Accession Number: 125592369. Language: English. Entry Date: 20171214. Revision Date: 20171021. Publication Type: journal article. Journal Subset: Biomedical; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. NLM UID: 9214524. SP - 1618 EP - 1624 JO - Psycho-Oncology JF - Psycho-Oncology JA - PSYCHO ONCOL VL - 26 IS - 10 CY - Hoboken, New Jersey PB - John Wiley & Sons, Inc. AB - Objective: Women diagnosed with breast cancer or ductal carcinoma in situ and those with a genetic susceptibility to developing this disease face the challenging decision of whether or not to undergo breast reconstruction following mastectomy. As part of a large randomized controlled trial, this qualitative study examined women's experiences of using the Breast RECONstruction Decision Aid (BRECONDA) and health professionals' feedback regarding the impact of this resource on patients' knowledge and decision making about breast reconstruction.Method: Semistructured interviews were conducted with women who accessed the BRECONDA intervention (N = 36) and with their healthcare providers (N = 6). All interviews were transcribed verbatim and subjected to thematic analysis by 3 independent coders.Results: Participants reported an overall positive impression, with all interviewees endorsing this decision aid as a useful resource for women considering reconstructive surgery. Thematic analysis of patient interviews revealed 4 themes: overall impressions and aesthetics; personal relevance and utility; introducing BRECONDA; and advantages and suggested improvements. Analysis of health professionals' interviews also revealed 4 themes: need for BRECONDA, impact of BRECONDA, potential difficulties that may arise in using the decision aid, and recommending BRECONDA to patients. Patients indicated that they derived benefit from this resource at all stages of their decision-making process, with the greatest perceived benefit being for those early in their breast reconstruction journey.Conclusion: These findings support the use of BRECONDA as an adjunct to clinical consultation and other information sources. SN - 1057-9249 AD - Centre for Emotional Health, Department of Psychology, Macquarie University AD - Westmead Breast Cancer Institute, Westmead Hospital, University of Sydney AD - Clinic for Surgery and Oncology & Clinical Nursing Research Unit, Aalborg University Hospital AD - Centre for Appearance Research, Faculty of Health & Applied Sciences, University of the West of England AD - Psychological Sciences, University of California AD - School of Psychology, The University of Auckland AD - Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University AD - Familial Cancer Service, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney Medical School, University of Sydney AD - Centre for Cancer Research, The Westmead Institute for Medical Research AD - Hereditary Cancer Clinic, Prince of Wales Hospital U2 - PMID: 27957772. DO - 10.1002/pon.4346 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=125592369&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 125843743 T1 - Weighting Experience-Based Decision Support on the Basis of Clinical Outcomes' Assessment...EFMI Special Topic Conference, 2017, Israel AU - MURO, Naiara AU - LARBURU, Nekane AU - BOUAUD, Jacques AU - SEROUSSI, Brigitte Y1 - 2017/10// N1 - Accession Number: 125843743. Language: English. Entry Date: 20171030. Revision Date: 20171030. Publication Type: Article; proceedings. Journal Subset: Computer/Information Science; Continental Europe; Editorial Board Reviewed; Europe; Peer Reviewed. NLM UID: 9214582. KW - Outcome Assessment KW - Decision Support Systems, Clinical KW - Practice Guidelines KW - Congresses and Conferences -- Israel KW - Israel KW - Adverse Health Care Event KW - Breast Neoplasms -- Therapy SP - 33 EP - 37 JO - Studies in Health Technology & Informatics JF - Studies in Health Technology & Informatics JA - STUD HEALTH TECHNOL INFORM VL - 244 PB - IOS Press AB - Technologies such as decision support systems are expected to help clinicians implement clinical practice guidelines (CPGs) with the aim of decreasing practice variations and improving clinical outcomes. However, if CPGs provide recommendations to improve patient care, they may fail to take into account actual clinical outcomes associated to the recommended treatment, such as adverse events or secondary effects. In this paper, we present a novel experiencebased decision support approach applied to the management of breast cancer, the most commonly diagnosed cancer among women worldwide. Capitalizing on the clinical know-how of physicians and the modeling of patient's outcomes and toxicities in a computer interpretable way, we are able to discover new knowledge that helps improving patient-centered clinical care. This work is conducted within the EU Horizon 2020 project DESIREE. SN - 0926-9630 AD - Sorbonne Universités, UPMC Univ Paris 06, INSERM, Université Paris 13, Sorbonne Paris Cité, UMR S 1142, LIMICS, Paris, France AD - eHealth and Biomedical Applications, Vicomtech-IK4, Donostia-San Sebastian, Spain AD - Biodonostia, Donostia-San Sebastian, Spain AD - AP-HP, DRCI, Paris, France AD - AP-HP, Hôpital Tenon, Département de Santé Publique, Paris, France DO - 10.3233/978-1-61499-824-2-33 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=125843743&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 125076311 T1 - BRCA Genetic Testing and Receipt of Preventive Interventions Among Women Aged 18-64 Years with Employer-Sponsored Health Insurance in Nonmetropolitan and Metropolitan Areas -- United States, 2009-2014. AU - Kolor, Katherine AU - Chen, Zhuo AU - Grosse, Scott D. AU - Rodriguez, Juan L. AU - Fisk Green, Ridgely AU - Dotson, W. David AU - Bowen, M. Scott AU - Lynch, Julie A. AU - Khoury, Muin J. Y1 - 2017/09/08/ N1 - Accession Number: 125076311. Language: English. Entry Date: 20170912. Revision Date: 20170913. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Public Health; USA. Special Interest: Oncologic Care; Women's Health. NLM UID: 101142015. KW - Breast Neoplasms -- Familial and Genetic KW - Breast Neoplasms -- Prevention and Control KW - Genes, BRCA -- Evaluation KW - Genetic Screening -- Trends KW - Genetic Counseling -- Trends KW - Tamoxifen -- Therapeutic Use KW - Prophylactic Mastectomy -- Trends KW - Health Resource Utilization -- Trends KW - Oncologic Care KW - Databases, Health KW - Health Benefit Plans, Employee KW - Urban Areas KW - Rural Areas KW - United States KW - Trend Studies KW - Female KW - Adolescence KW - Adult KW - Middle Age KW - Descriptive Statistics KW - Mastectomy KW - Magnetic Resonance Imaging KW - Mammography KW - Health Services Accessibility KW - Disease Surveillance KW - Guideline Adherence KW - Healthcare Disparities KW - Oophorectomy KW - Mutation KW - Data Analytics KW - Prospective Studies KW - Human SP - 1 EP - 11 JO - MMWR Surveillance Summaries JF - MMWR Surveillance Summaries JA - MMWR SURVEILLANCE SUMM VL - 66 IS - 15 CY - Atlanta, Georgia PB - Centers for Disease Control & Prevention (CDC) AB - Problem/Condition: Genetic testing for breast cancer 1 (BRCA1) and breast cancer 2 (BRCA2) gene mutations can identify women at increased risk for breast and ovarian cancer. These testing results can be used to select preventive interventions and guide treatment. Differences between nonmetropolitan and metropolitan populations in rates of BRCA testing and receipt of preventive interventions after testing have not previously been examined. Period Covered: 2009-2014. Description of System: Medical claims data from Truven Health Analytics MarketScan Commercial Claims and Encounters databases were used to estimate rates of BRCA testing and receipt of preventive interventions after BRCA testing among women aged 18-64 years with employer-sponsored health insurance in metropolitan and nonmetropolitan areas of the United States, both nationally and regionally. Results: From 2009 to 2014, BRCA testing rates per 100,000 women aged 18-64 years with employer-sponsored health insurance increased 2.3 times (102.7 to 237.8) in metropolitan areas and 3.0 times (64.8 to 191.3) in nonmetropolitan areas. The relative difference in BRCA testing rates between metropolitan and nonmetropolitan areas decreased from 37% in 2009 (102.7 versus 64.8) to 20% in 2014 (237.8 versus 191.3). The relative difference in BRCA testing rates between metropolitan and nonmetropolitan areas decreased more over time in younger women than in older women and decreased in all regions except the West. Receipt of preventive services 90 days after BRCA testing in metropolitan versus nonmetropolitan areas throughout the period varied by service: the percentage of women who received a mastectomy was similar, the percentage of women who received magnetic resonance imaging of the breast was lower in nonmetropolitan areas (as low as 5.8% in 2014 to as high as 8.2% in 2011) than metropolitan areas (as low as 7.3% in 2014 to as high as 10.3% in 2011), and the percentage of women who received mammography was lower in nonmetropolitan areas in earlier years but was similar in later years. Interpretation: Possible explanations for the 47% decrease in the relative difference in BRCA testing rates over the study period include increased access to genetic services in nonmetropolitan areas and increased demand nationally as a result of publicity. The relative differences in metropolitan and nonmetropolitan BRCA testing rates were smaller among women at younger ages compared with older ages. Public Health Action: Improved data sources and surveillance tools are needed to gather comprehensive data on BRCA testing in the United States, monitor adherence to evidence-based guidelines for BRCA testing, and assess receipt of preventive interventions for women with BRCA mutations. Programs can build on the recent decrease in geographic disparities in receipt of BRCA testing while simultaneously educating the public and health care providers about U.S. Preventive Services Task Force recommendations and other clinical guidelines for BRCA testing and counseling. SN - 1546-0738 AD - Office of Public Health Genomics, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia AD - CFO Leasing, Inc., Atlanta, Georgia AD - Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia AD - National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia AD - Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia AD - Carter Consulting, Inc., Atlanta, Georgia AD - US Department of Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=125076311&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 125095094 T1 - Considering Genetic Testing? A Decision Support Tool for Young Women with Breast Cancer. Y1 - 2017/09// N1 - Accession Number: 125095094. Language: English. Entry Date: 20171228. Revision Date: 20171228. Publication Type: Article. Journal Subset: Nursing; Peer Reviewed; USA. KW - Breast Neoplasms KW - Genetic Screening KW - Decision Support Systems, Clinical KW - Cancer Patients KW - Decision Making KW - Chemotherapy, Cancer KW - Mutation SP - 438 EP - 438 JO - Journal of Oncology Navigation & Survivorship JF - Journal of Oncology Navigation & Survivorship JA - J ONCOL NAVIGATION SURVIVORSHIP VL - 8 IS - 9 CY - Cranbury, New Jersey PB - Green Hill Healthcare Communications, LLC SN - 2166-0999 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=125095094&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 125374533 T1 - Evaluation of a Stratified National Breast Screening Program in the United Kingdom: An Early Model-Based Cost-Effectiveness Analysis. AU - Gray, Ewan AU - Donten, Anna AU - Karssemeijer, Nico AU - van Gils, Carla AU - Evans, D. Gareth AU - Astley, Sue AU - Payne, Katherine Y1 - 2017/09// N1 - Accession Number: 125374533. Language: English. Entry Date: 20171021. Revision Date: 20171021. Publication Type: journal article. Journal Subset: Biomedical; Peer Reviewed; USA. Instrumentation: Longitudinal Interval Follow-Up Evaluation (LIFE); Ferrans and Powers Quality of Life Index. NLM UID: 100883818. KW - Quality-Adjusted Life Years KW - Mammography -- Methods KW - Health Screening -- Methods KW - Decision Support Techniques KW - Breast Neoplasms -- Diagnosis KW - Breast Neoplasms -- Economics KW - Mammography -- Economics KW - Relative Risk KW - Cost Benefit Analysis KW - Decision Making KW - Female KW - Health Screening -- Economics KW - Ferrans and Powers Quality of Life Index SP - 1100 EP - 1109 JO - Value in Health JF - Value in Health JA - VALUE HEALTH VL - 20 IS - 8 CY - New York, New York PB - Elsevier B.V. AB - Objectives: To identify the incremental costs and consequences of stratified national breast screening programs (stratified NBSPs) and drivers of relative cost-effectiveness.Methods: A decision-analytic model (discrete event simulation) was conceptualized to represent four stratified NBSPs (risk 1, risk 2, masking [supplemental screening for women with higher breast density], and masking and risk 1) compared with the current UK NBSP and no screening. The model assumed a lifetime horizon, the health service perspective to identify costs (£, 2015), and measured consequences in quality-adjusted life-years (QALYs). Multiple data sources were used: systematic reviews of effectiveness and utility, published studies reporting costs, and cohort studies embedded in existing NBSPs. Model parameter uncertainty was assessed using probabilistic sensitivity analysis and one-way sensitivity analysis.Results: The base-case analysis, supported by probabilistic sensitivity analysis, suggested that the risk stratified NBSPs (risk 1 and risk-2) were relatively cost-effective when compared with the current UK NBSP, with incremental cost-effectiveness ratios of £16,689 per QALY and £23,924 per QALY, respectively. Stratified NBSP including masking approaches (supplemental screening for women with higher breast density) was not a cost-effective alternative, with incremental cost-effectiveness ratios of £212,947 per QALY (masking) and £75,254 per QALY (risk 1 and masking). When compared with no screening, all stratified NBSPs could be considered cost-effective. Key drivers of cost-effectiveness were discount rate, natural history model parameters, mammographic sensitivity, and biopsy rates for recalled cases. A key assumption was that the risk model used in the stratification process was perfectly calibrated to the population.Conclusions: This early model-based cost-effectiveness analysis provides indicative evidence for decision makers to understand the key drivers of costs and QALYs for exemplar stratified NBSP. SN - 1098-3015 AD - Manchester Centre for Health Economics, University of Manchester, Manchester, UK AD - Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK AD - Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands AD - University Medical Centre Utrecht, Utrecht, Netherlands AD - Genesis Breast Cancer Prevention Centre and Nightingale Breast Screening Centre, University Hospital of South Manchester, Manchester, UK AD - Department of Imaging Science and Biomedical Engineering, University of Manchester, Manchester, UK U2 - PMID: 28964442. DO - 10.1016/j.jval.2017.04.012 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=125374533&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 124647933 T1 - Use of Biomarkers to Guide Decisions on Adjuvant Systemic Therapy for Women With Early-Stage Invasive Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline Focused Update. AU - Krop, Ian AU - Ismaila, Nofisat AU - Andre, Fabrice AU - Bast, Robert C. AU - Barlow, William AU - Collyar, Deborah E. AU - Hammond, M. Elizabeth AU - Kuderer, Nicole M. AU - Liu, Minetta C. AU - Mennel, Robert G. AU - Van Poznak, Catherine AU - Wolff, Antonio C. AU - Stearns, Vered Y1 - 2017/08/20/ N1 - Accession Number: 124647933. Language: English. Entry Date: 20170919. Revision Date: 20170919. Publication Type: journal article; practice guidelines. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Instrumentation: Clinical Decision Making in Nursing Scale (CDMNS) (Jenkins). NLM UID: 8309333. KW - Breast Neoplasms -- Metabolism KW - Breast Neoplasms -- Drug Therapy KW - Decision Making KW - Female KW - Chemotherapy, Adjuvant KW - Decision Support Techniques KW - Scales SP - 2838 EP - 2850 JO - Journal of Clinical Oncology JF - Journal of Clinical Oncology JA - J CLIN ONCOL VL - 35 IS - 24 CY - Alexandria, Virginia PB - American Society of Clinical Oncology AB - Purpose This focused update addresses the use of MammaPrint (Agendia, Irvine, CA) to guide decisions on the use of adjuvant systemic therapy. Methods ASCO uses a signals approach to facilitate guideline updates. For this focused update, the publication of the phase III randomized MINDACT (Microarray in Node-Negative and 1 to 3 Positive Lymph Node Disease May Avoid Chemotherapy) study to evaluate the MammaPrint assay in 6,693 women with early-stage breast cancer provided a signal. An expert panel reviewed the results of the MINDACT study along with other published literature on the MammaPrint assay to assess for evidence of clinical utility. Recommendations If a patient has hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative, node-negative breast cancer, the MammaPrint assay may be used in those with high clinical risk to inform decisions on withholding adjuvant systemic chemotherapy due to its ability to identify a good-prognosis population with potentially limited chemotherapy benefit. Women in the low clinical risk category did not benefit from chemotherapy regardless of genomic MammaPrint risk group. Therefore, the MammaPrint assay does not have clinical utility in such patients. If a patient has hormone receptor-positive, HER2-negative, node-positive breast cancer, the MammaPrint assay may be used in patients with one to three positive nodes and a high clinical risk to inform decisions on withholding adjuvant systemic chemotherapy. However, such patients should be informed that a benefit from chemotherapy cannot be excluded, particularly in patients with greater than one involved lymph node. The clinician should not use the MammaPrint assay to guide decisions on adjuvant systemic therapy in patients with hormone receptor-positive, HER2-negative, node-positive breast cancer at low clinical risk, nor any patient with HER2-positive or triple-negative breast cancer, because of the lack of definitive data in these populations. Additional information can be found at www.asco.org/breast-cancer-guidelines and www.asco.org/guidelineswiki . SN - 0732-183X AD - Dana-Farber Cancer Institute, Boston, MA. AD - American Society of Clinical Oncology, Alexandria, VA. AD - Institute Gustave Roussy, Paris, France. AD - The University of Texas MD Anderson Cancer Center, Houston, TX. AD - Cancer Research and Biostatistics, Seattle, WA. AD - Patient Advocates in Research, Danville, CA. AD - University of Utah and Intermountain Health Care, Salt Lake City, UT. AD - University ofWashingtonMedical Center, Seattle,WA. AD - Mayo Clinic College ofMedicine, Rochester, MN. AD - Baylor UniversityMedical Center, Texas Oncology PA, Dallas, TX. AD - University of Michigan, Ann Arbor, MI. AD - Johns Hopkins University, Baltimore, MD. U2 - PMID: 28692382. DO - 10.1200/JCO.2017.74.0472 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=124647933&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 124443671 T1 - Developing a patient decision aid for the treatment of women with early stage breast cancer: the struggle between simplicity and complexity. AU - Savelberg, W. AU - van der Weijden, T. AU - Boersma, L. AU - Smidt, M. AU - Willekens, C. AU - Moser, A. Y1 - 2017/08//8/1/2017 N1 - Accession Number: 124443671. Language: English. Entry Date: In Process. Revision Date: 20170807. Publication Type: journal article. Journal Subset: Biomedical; Computer/Information Science; Europe; UK & Ireland. NLM UID: 101088682. SP - 1 EP - 13 JO - BMC Medical Informatics & Decision Making JF - BMC Medical Informatics & Decision Making JA - BMC MED INFORM DECIS MAKING VL - 17 PB - BioMed Central AB - Background: A patient decision aid (PtDA) can support shared decision making (SDM) in preference-sensitive care, with more than one clinically applicable treatment option. The development of a PtDA is a complex process, involving several steps, such as designing, developing and testing the draft with all the stakeholders, known as alpha testing. This is followed by testing in 'real life' situations, known as beta testing, and then finalising the definite version. Our aim was developing and alpha testing a PtDA for primary treatment of early stage breast cancer, ensuring that the tool is considered relevant, valid and feasible by patients and professionals.Methods: Our qualitative descriptive study applied various methods including face-to-face think-aloud interviews, a focus group and semi-structured telephone interviews. The study population consisted of breast cancer patients facing the choice between breast-conserving therapy with or without preceding neo-adjuvant chemotherapy and mastectomy, and professionals involved in breast cancer care in dedicated multidisciplinary breast cancer teams.Results: A PtDA was developed in four iterative test rounds, taking nearly 2 years, involving 26 patients and 26 professionals. While the research group initially opted for simplicity for the sake of implementation, the clinicians objected that the complexity of the decision could not be ignored. Other topics of concern were the conflicting views of professionals and patients regarding side effects, the amount of information and how to present it.Conclusion: The development was an extensive process, because the professionals rejected the simplifications proposed by the research group. This resulted in the development of a completely new draft PtDA, which took double the expected time and resources. The final version of the PtDA appeared to be well-appreciated by professionals and patients, although its acceptability will only be proven in actual practice (beta testing).Trial Registration: NTR TC 5721 . SN - 1472-6947 AD - Oncology Centre, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands AD - School for Public Health and Primary Care (CAPHRI) Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands AD - Department of Family Medicine, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands AD - Department of Radiotherapy, Maastricht University Medical Center, (MAASTRO clinic) Dr. Tanslaan 12, 6229 ET Maastricht, The Netherlands AD - SBOH (Foundation for vocational training in family medicine), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands AD - Zuyd University of Applied Sciences, Nieuw Eyckholt 300, 6419 DJ Heerlen, The Netherlands U2 - PMID: 28764688. DO - 10.1186/s12911-017-0505-6 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=124443671&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 124715947 T1 - Quality of Patient Decisions About Breast Reconstruction After Mastectomy. AU - Nan-hi Lee, Clara AU - Deal, Allison M. AU - Huh, Ruth AU - Ubel, Peter Anthony AU - Yuen-Jong Liu AU - Blizard, Lillian AU - Hunt, Caprice AU - Pignone, Michael Patrick AU - Lee, Clara Nan-Hi AU - Liu, Yuen-Jong Y1 - 2017/08// N1 - Accession Number: 124715947. Language: English. Entry Date: 20170919. Revision Date: 20170919. Publication Type: journal article; clinical trial; research. Journal Subset: Biomedical; USA. Special Interest: Evidence-Based Practice. Instrumentation: Body Image Scale. Grant Information: P50 CA058223/CA/NCI NIH HHS/United States. NLM UID: 101589553. KW - Decision Making KW - Carcinoma, Ductal, Breast -- Psychosocial Factors KW - Breast Reconstruction -- Psychosocial Factors KW - Adenocarcinoma -- Psychosocial Factors KW - Carcinoma, Lobular -- Psychosocial Factors KW - Breast Neoplasms -- Psychosocial Factors KW - Prospective Studies KW - Human KW - Carcinoma, Ductal, Breast -- Surgery KW - Adenocarcinoma -- Surgery KW - Cross Sectional Studies KW - Mastectomy -- Psychosocial Factors KW - Female KW - Middle Age KW - Attitude to Health KW - Quality of Life KW - Patient Satisfaction KW - Breast Neoplasms -- Surgery KW - Carcinoma, Lobular -- Surgery KW - Clinical Trials KW - Validation Studies KW - Comparative Studies KW - Evaluation Research KW - Multicenter Studies KW - Scales SP - 741 EP - 748 JO - JAMA Surgery JF - JAMA Surgery JA - JAMA SURG VL - 152 IS - 8 CY - Chicago, Illinois PB - American Medical Association AB - Importance: Breast reconstruction has the potential to improve a person's body image and quality of life but has important risks. Variations in who undergoes breast reconstruction have led to questions about the quality of patient decisions.Objective: To assess the quality of patient decisions about breast reconstruction.Design, Setting, and Participants: A prospective, cross-sectional survey study was conducted from June 27, 2012, to February 28, 2014, at a single, academic, multidisciplinary oncology clinic among women planning to undergo mastectomy for stage I to III invasive ductal or lobular breast cancer, ductal carcinoma in situ, or prophylaxis.Exposures: Mastectomy only and mastectomy with reconstruction.Main Outcome and Measures: Knowledge, as ascertained using the Decision Quality Instrument; preference concordance, based on rating and ranking of key attributes; and decision quality, defined as having knowledge of 50% or more and preference concordance.Results: During the 20-month period, 214 patients were eligible, 182 were approached, and 32 missed. We enrolled 145 patients (79.7% enrollment rate), and received surveys from 131 patients (72.0% participation rate). Five participants became ineligible. The final study population was 126 patients. Among the 126 women in the study (mean [SD] age, 53.2 [12.1] years), the mean (SD) knowledge score was 58.5% (16.2%) and did not differ by treatment group (mastectomy only, 55.2% [15.0%]; mastectomy with reconstruction, 60.5% [16.5%]). A total of 82 of 123 participants (66.7%) had a calculated treatment preference of mastectomy only; 39 of these women (47.6%) underwent mastectomy only. A total of 41 participants (32.5%) had a calculated treatment preference of mastectomy with reconstruction; 36 of these women (87.8%) underwent mastectomy with reconstruction. Overall, 52 of 120 participants (43.3%) made a high-quality decision. In multivariable analysis, white race/ethnicity (odds ratio [OR], 2.72; 95% CI, 1.00-7.38; P = .05), having private insurance (OR, 1.61; 95% CI, 1.35-1.93; P < .001), having a high school education or less (vs some college) (OR, 4.84; 95% CI, 1.22-19.21; P = .02), having a college degree (vs some college) (OR, 1.95; 95% CI, 1.53-2.49; P < .001), and not having a malignant neoplasm (eg, BRCA carriers) (OR, 3.13; 95% CI, 1.25-7.85; P = .01) were independently associated with making a high-quality decision.Conclusions and Relevance: A minority of patients undergoing mastectomy in a single academic center made a high-quality decision about reconstruction. Shared decision making is needed to support decisions about breast reconstruction. SN - 2168-6254 AD - Department of Plastic Surgery, College of Medicine, The Ohio State University, Columbus AD - Richard J. Solove Research Institute, Comprehensive Cancer Center-Arthur G. James Cancer Hospital, The Ohio State University, Columbus AD - Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus AD - Lineberger Comprehensive Cancer Center Biostatistics Core Facility, University of North Carolina-Chapel Hill AD - Duke-Margolis Center for Health Policy, Fuqua School of Business, Duke University, Durham, North Carolina AD - Duke-Margolis Center for Health Policy, Sanford School of Public Policy, Duke University, Durham, North Carolina AD - Duke-Margolis Center for Health Policy, Duke University School of Medicine, Durham, North Carolina AD - Department of Surgery, University of North Carolina Hospitals, University of North Carolina-Chapel Hill AD - Gastrointestinal Unit, Massachusetts General Hospital, Boston AD - Department of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina-Chapel Hill AD - Department of Internal Medicine, Dell Medical School, University of Texas at Austin AD - Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina AD - Department of Plastic Surgery, College of Medicine, The Ohio State University, Columbus2Richard J. Solove Research Institute, Comprehensive Cancer Center-Arthur G. James Cancer Hospital, The Ohio State University, Columbus3Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus U2 - PMID: 28467530. DO - 10.1001/jamasurg.2017.0977 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=124715947&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 123992112 T1 - Why Is Cancer Genetic Counseling Underutilized by Women Identified as at Risk for Hereditary Breast Cancer? Patient Perceptions of Barriers Following a Referral Letter. AU - Kne, Alyssa AU - Zierhut, Heather AU - Baldinger, Shari AU - Swenson, Karen AU - Mink, Pamela AU - Veach, Patricia AU - Tsai, Michaela Y1 - 2017/08// N1 - Accession Number: 123992112. Language: English. Entry Date: 20170712. Revision Date: 20170713. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Continental Europe; Europe; Peer Reviewed. NLM UID: 9206865. KW - Genetic Counseling KW - Genes, Neoplasm KW - Breast Neoplasms KW - Health Services Accessibility KW - Referral and Consultation KW - Human KW - Female KW - Family History KW - Support, Psychosocial KW - Mammography KW - Thematic Analysis KW - Decision Making, Patient SP - 697 EP - 715 JO - Journal of Genetic Counseling JF - Journal of Genetic Counseling JA - J GENETIC COUNS VL - 26 IS - 4 CY - , PB - Springer Science & Business Media B.V. AB - Family history information comprises an important tool in identifying and referring patients at risk for hereditary breast and ovarian cancer (HBOC) to cancer genetic counseling. Despite recommendations and support provided by numerous professional organizations, cancer genetic counseling services are underutilized by atrisk patients. This study aimed to: (1) determine the rate of genetic counseling utilization following a referral letter, (2) characterize factors (barriers and supports) which influenced uptake of services, and (3) identify potential strategies for increasing utilization. This study evaluated the uptake of cancer genetic counseling among 603 screening mammography patients identified as having an increased risk for HBOC based on National Comprehensive Cancer Network (NCCN) guidelines. At risk individuals and their primary care providers were mailed a referral letter recommending genetic counseling. Three focus groups ( N = 24) were conducted to identify responses to receiving a letter recommending genetic counseling, barriers to seeking genetic counseling, and facilitating factors to utilizing these services. Participant responses were qualitatively analyzed using thematic and cross case analysis. Within one year, 50/603 (8 %) of the identified at-risk women completed a genetic counseling appointment. Participant-perceived barriers which influenced their decision not to seek genetic counseling included lack of relevance and utility, limited knowledge about genetic counseling, concerns about the genetic counseling process, and concerns about cost and insurance coverage. Participant-perceived facilitating factors which would support a decision to seek genetic counseling included greater awareness and education about genetic counseling services when receiving a referral, and improved follow up and guidance from their provider. Findings from this study support the need for patient and primary care provider education, and improved provider-patient communication to increase uptake of genetic counseling services. SN - 1059-7700 AD - University of Minnesota-Fairview , Minneapolis USA AD - Department of Genetics, Cell Biology and Development , University of Minnesota , Minneapolis USA AD - Allina Health , Virginia Piper Cancer Institute , 800 East 28th Street, Suite 602 Minneapolis 55407 USA AD - Division of Applied Research , Allina Health , Minneapolis USA DO - 10.1007/s10897-016-0040-0 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=123992112&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 123928435 T1 - Breast cancer prevention strategies in lobular carcinoma in situ: A decision analysis. AU - Wong, Stephanie M. AU - Stout, Natasha K. AU - Punglia, Rinaa S. AU - Prakash, Ipshita AU - Sagara, Yasuaki AU - Golshan, Mehra Y1 - 2017/07/15/ N1 - Accession Number: 123928435. Language: English. Entry Date: In Process. Revision Date: 20170903. Publication Type: journal article. Journal Subset: Biomedical; Peer Reviewed; USA. Instrumentation: Longitudinal Interval Follow-Up Evaluation (LIFE); Ferrans and Powers Quality of Life Index; Global Appraisal of Individual Needs (GAIN). NLM UID: 0374236. KW - Antineoplastic Agents -- Therapeutic Use KW - Chemoprevention KW - Outcomes (Health Care) KW - Carcinoma, Lobular -- Prevention and Control KW - Breast Neoplasms -- Therapy KW - Survival KW - Decision Support Techniques KW - Probability KW - Breast Neoplasms -- Prevention and Control KW - Quality-Adjusted Life Years KW - Aged KW - Carcinoma, Lobular -- Mortality KW - Life Expectancy KW - Breast Neoplasms -- Mortality KW - Middle Age KW - Decision Trees KW - Female KW - Clinical Assessment Tools KW - Ferrans and Powers Quality of Life Index SP - 2609 EP - 2617 JO - Cancer (0008543X) JF - Cancer (0008543X) JA - CANCER VL - 123 IS - 14 CY - Hoboken, New Jersey PB - John Wiley & Sons, Inc. AB - Background: Women diagnosed with lobular carcinoma in situ (LCIS) have a 3-fold to 10-fold increased risk of developing invasive breast cancer. The objective of this study was to evaluate the life expectancy (LE) and differences in survival offered by active surveillance, risk-reducing chemoprevention, and bilateral prophylactic mastectomy among women with LCIS.Methods: A Markov simulation model was constructed to determine average LE and quality-adjusted LE (QALE) gains for hypothetical cohorts of women diagnosed with LCIS at various ages under alternative risk-reduction strategies. Probabilities for invasive breast cancer, breast cancer-specific mortality, other-cause mortality and the effectiveness of preventive strategies were derived from published studies and from the National Cancer Institute's Surveillance, Epidemiology, and End Results database.Results: Assuming a breast cancer incidence from 1.02% to 1.37% per year under active surveillance, a woman aged 50 years diagnosed with LCIS would have a total LE of 32.78 years and would gain 0.13 years (1.6 months) in LE by adding chemoprevention and 0.25 years (3.0 months) in LE by adding bilateral prophylactic mastectomy. After quality adjustment, chemoprevention resulted in the greatest QALE for women ages 40 to 60 years at LCIS diagnosis, whereas surveillance remained the preferred strategy for optimizing QALE among women diagnosed at age 65 years and older.Conclusions: In this model, among women with a diagnosis of LCIS, breast cancer prevention strategies only modestly affected overall survival, whereas chemoprevention was modeled as the preferred management strategy for optimizing invasive disease-free survival while prolonging QALE form women younger than 65 years. Cancer 2017;123:2609-17. © 2017 American Cancer Society. SN - 0008-543X AD - Harvard School of Public Health AD - Department of Surgery, McGill University Health Center AD - Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute AD - Department of Radiation Oncology Brigham, and Women's Hospital/Dana-Farber Cancer Institute Harvard Medical School AD - Department of Breast Oncology, Sagara Hospital, Hakuaikai Medical Corporation AD - Department of Surgery, Brigham and Women's Hospital/Dana-Farber Cancer Institute Harvard Medical School U2 - PMID: 28221673. DO - 10.1002/cncr.30644 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=123928435&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 123501198 T1 - Information Needs of Older Women With Early-Stage Breast Cancer When Making Radiation Therapy Decisions. AU - Wang, Shi-Yi AU - Kelly, Gabrielle AU - Gross, Cary AU - Killelea, Brigid K. AU - Mougalian, Sarah AU - Presley, Carolyn AU - Fraenkel, Liana AU - Evans, Suzanne B. Y1 - 2017/07/15/ N1 - Accession Number: 123501198. Language: English. Entry Date: 20170801. Revision Date: 20170801. Publication Type: journal article. Journal Subset: Biomedical; Peer Reviewed; USA. Instrumentation: Wide Range Achievement Test (WRAT); Longitudinal Interval Follow-Up Evaluation (LIFE); Impact of Events Scale (IES). Grant Information: K24 AR060231/AR/NIAMS NIH HHS/United States. NLM UID: 7603616. KW - Decision Making KW - Breast Neoplasms -- Radiotherapy KW - Breast Neoplasms -- Pathology KW - Family KW - Patient Education KW - Friendship KW - Quality of Life KW - Socioeconomic Factors KW - Radiotherapy, Adjuvant -- Psychosocial Factors KW - Female KW - Age Factors KW - Radiotherapy -- Psychosocial Factors KW - Aged KW - Breast Neoplasms -- Psychosocial Factors KW - Prognosis KW - Lumpectomy KW - Breast Neoplasms -- Surgery KW - Radiotherapy -- Adverse Effects KW - Physician's Role KW - Impact of Events Scale SP - 733 EP - 740 JO - International Journal of Radiation Oncology, Biology, Physics JF - International Journal of Radiation Oncology, Biology, Physics JA - INT J RADIAT ONCOL BIOL PHYS VL - 98 IS - 4 PB - Pergamon Press - An Imprint of Elsevier Science AB - Purpose: To identify the information older women with early-stage breast cancer need when making radiation therapy decisions, and who patients identify as the main decision maker.Methods and Materials: We surveyed (through face-to-face interview, telephone, or mail) women aged ≥65 years who received lumpectomy and were considering or receiving adjuvant radiation therapy for early-stage breast cancer. The survey instrument was constructed with input from patient and professional advisory committees, including breast cancer survivors, advocates of breast cancer care and aging, clinicians, and researchers. Participants rated the importance (on a 4-point scale) of 24 statements describing the benefits, side effects, impact on daily life, and other issues of radiation therapy in relation to radiation therapy decision making. Participants also designated who was considered the key decision maker.Results: The response rate was 56.4% (93 of 165). Mean age was 72.5 years, ranging from 65 to 93 years. More than 96% of participants indicated they were the main decision maker on receiving radiation therapy. There was wide variation in information needs regarding radiation therapy decision making. Participants rated a mean of 18 (range, 3-24) items as "essential." Participants rated items related to benefits highest, followed by side effects. Participants who were older than 75 years rated 13.9 questions as essential, whereas participants aged ≤74 years rated 18.7 as essential (P=.018).Conclusions: Older women desire information and have more agency and input in the decision-making process than prior literature would suggest. The variation in information needs indicates that future decision support tools should provide options to select what information would be of interest to the participants. SN - 0360-3016 AD - Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut AD - Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of Medicine, New Haven, Connecticut AD - Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut AD - Department of Surgery, Yale University School of Medicine, New Haven, Connecticut AD - Section of Medical Oncology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut AD - Section of Rheumatology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut AD - Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut U2 - PMID: 28366581. DO - 10.1016/j.ijrobp.2017.02.001 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=123501198&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 124317623 T1 - A systematic review of women's satisfaction and regret following risk-reducing mastectomy. AU - Braude, Lucy AU - Kirsten, Laura AU - Gilchrist, Jemma AU - Juraskova, Ilona Y1 - 2017/07// N1 - Accession Number: 124317623. Language: English. Entry Date: 20171129. Revision Date: 20171115. Publication Type: journal article; review. Journal Subset: Core Nursing; Europe; Health Promotion/Education; Nursing; Peer Reviewed; UK & Ireland. NLM UID: 8406280. SP - N.PAG EP - N.PAG JO - Patient Education & Counseling JF - Patient Education & Counseling JA - PATIENT EDUC COUNS VL - 100 IS - 7 PB - Elsevier B.V. AB - Objective: A systematic review of quantitative and qualitative studies, to describe patient satisfaction and regret associated with risk-reducing mastectomies (RRM), and the patient-reported factors associated with these among women at high risk of developing breast cancer.Methods: Studies were identified using Medline, CINAHL, Embase and PsycInfo databases (1995-2016). Data were extracted and crosschecked for accuracy. Article quality was assessed using standardised criteria.Results: Of the 1657 unique articles identified, 30 studies met the inclusion criteria (n=23 quantitative studies, n=3 qualitative studies, n=4 mixed-method studies). Studies included were cross-sectional (n=23) or retrospective (n=7). General satisfaction with RRM, decision satisfaction and aesthetic satisfaction were generally high, although some women expressed regret around their decision and dissatisfaction with their appearance. Factors associated with both patient satisfaction and regret included: post-operative complications, body image changes, psychological distress and perceived inadequacy of information.Conclusion: While satisfaction with RRM was generally high, some women had regrets and expressed dissatisfaction. Future research is needed to further explore RRM, and to investigate current satisfaction trends given the ongoing improvements to surgical and clinical practice.Practice Implications: Offering pre-operative preparation, decisional support and continuous psychological input may help to facilitate satisfaction with this complex procedure. SN - 0738-3991 AD - School of Psychology, The University of Sydney, Sydney, Australia AD - Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, Sydney, Australia; Nepean Cancer Care Centre, Sydney West Cancer Network, Sydney, Australia AD - Norwest Private Hospital, Sydney, Australia AD - School of Psychology, The University of Sydney, Sydney, Australia; Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, Sydney, Australia U2 - PMID: 28732648. DO - 10.1016/j.pec.2017.06.032 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=124317623&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 123199649 T1 - Family-building After Breast Cancer: Considering the Effect on Adherence to Adjuvant Endocrine Therapy. AU - Benedict, Catherine AU - Thom, Bridgette AU - Teplinsky, Eleonora AU - Carleton, Jane AU - Kelvin, Joanne F. Y1 - 2017/06// N1 - Accession Number: 123199649. Language: English. Entry Date: In Process. Revision Date: 20170601. Publication Type: journal article. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 100898731. SP - 165 EP - 170 JO - Clinical Breast Cancer JF - Clinical Breast Cancer JA - CLIN BREAST CANCER VL - 17 IS - 3 CY - New York, New York PB - Elsevier B.V. AB - Adherence to endocrine therapy (ET) is a longstanding problem in breast cancer (BC) survivorship care, particularly among younger women. Younger patients have reported lower ET initiation rates and greater rates of early discontinuation and are considered an "at risk" group for nonadherence. For women who hope to have children in the future, concerns about premature menopause and the implications of postponing childbearing for the 5 to 10 years of ET are widespread. Preliminary evidence suggests that prioritizing fertility, along with concerns about side effects, leads to ET noninitiation and early discontinuation. Clinical efforts to improve adherence might need to consider patients' family-building goals during the course of treatment and to appropriately counsel patients according to their priorities and family-building intentions. Educational materials about family building after cancer are still not consistently available or provided. Helping patients to access trusted informational resources and decision support tools, in conjunction with medical counseling, will promote informed decisions regarding ET adherence and pregnancy that are medically appropriate. Such shared patient-provider decision-making about ET adherence and pregnancy could help to maximize patient autonomy by incorporating their values, preferences, and priorities into decisions, using providers' medical expertise. SN - 1526-8209 AD - Department of Medicine, Hofstra Northwell School of Medicine, Manhasset, N.Y. AD - Survivorship Center, Memorial Sloan Kettering Cancer Center, New York, N.Y. AD - Hofstra Northwell School of Medicine, Monter Cancer Center, New Hyde Park, N.Y. U2 - PMID: 28087390. DO - 10.1016/j.clbc.2016.12.002 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=123199649&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 123206580 T1 - An updated PREDICT breast cancer prognostication and treatment benefit prediction model with independent validation. AU - dos Reis, Francisco J. Candido AU - Wishart, Gordon C. AU - Dicks, Ed M. AU - Greenberg, David AU - Rashbass, Jem AU - Schmidt, Marjanka K. AU - van den Broek, Alexandra J. AU - Ellis, Ian O. AU - Green, Andrew AU - Rakha, Emad AU - Maishman, Tom AU - Eccles, Diana M. AU - Pharoah, Paul D. P. AU - Candido Dos Reis, Francisco J Y1 - 2017/05/22/ N1 - Accession Number: 123206580. Language: English. Entry Date: In Process. Revision Date: 20170601. Publication Type: journal article. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. NLM UID: 100927353. SP - 1 EP - 13 JO - Breast Cancer Research JF - Breast Cancer Research JA - BREAST CANCER RES VL - 19 PB - BioMed Central AB - Background: PREDICT is a breast cancer prognostic and treatment benefit model implemented online. The overall fit of the model has been good in multiple independent case series, but PREDICT has been shown to underestimate breast cancer specific mortality in women diagnosed under the age of 40. Another limitation is the use of discrete categories for tumour size and node status resulting in 'step' changes in risk estimates on moving between categories. We have refitted the PREDICT prognostic model using the original cohort of cases from East Anglia with updated survival time in order to take into account age at diagnosis and to smooth out the survival function for tumour size and node status.Methods: Multivariable Cox regression models were used to fit separate models for ER negative and ER positive disease. Continuous variables were fitted using fractional polynomials and a smoothed baseline hazard was obtained by regressing the baseline cumulative hazard for each patients against time using fractional polynomials. The fit of the prognostic models were then tested in three independent data sets that had also been used to validate the original version of PREDICT.Results: In the model fitting data, after adjusting for other prognostic variables, there is an increase in risk of breast cancer specific mortality in younger and older patients with ER positive disease, with a substantial increase in risk for women diagnosed before the age of 35. In ER negative disease the risk increases slightly with age. The association between breast cancer specific mortality and both tumour size and number of positive nodes was non-linear with a more marked increase in risk with increasing size and increasing number of nodes in ER positive disease. The overall calibration and discrimination of the new version of PREDICT (v2) was good and comparable to that of the previous version in both model development and validation data sets. However, the calibration of v2 improved over v1 in patients diagnosed under the age of 40.Conclusions: The PREDICT v2 is an improved prognostication and treatment benefit model compared with v1. The online version should continue to aid clinical decision making in women with early breast cancer. SN - 1465-5411 AD - Department of Gynaecology and Obstetrics, Ribeirao Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil AD - Faculty of Medical Science, Anglia Ruskin University, Cambridge, UK AD - Department of Oncology, University of Cambridge, Cambridge, UK AD - National Cancer Registration and Analysis Service, Public Health England, London, UK AD - Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands AD - Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands AD - Division of Cancer and Stem Cells, School of Medicine, University of Nottingham and Nottingham University Hospitals NHS Trust, City Hospital, Nottingham, UK AD - Cancer Sciences Academic Unit and Southampton Clinical Trials Unit, Faculty of Medicine, University of Southampton and University Hospital Southampton Foundation Trust, Southampton, UK U2 - PMID: 28532503. DO - 10.1186/s13058-017-0852-3 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=123206580&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - ID - 123087690 T1 - Tailoring Adjuvant Therapy for Breast Cancer in the Elderly: Room for Improvement. AU - Anampa, Jesus AU - Sparano, Joseph A. Y1 - 2017/05//May/Jun2017 N1 - Accession Number: 123087690. Language: English. Entry Date: 20170519. Revision Date: 20170522. Publication Type: Editorial; editorial. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Peer Reviewed; USA. NLM UID: 9505539. KW - Breast Neoplasms -- Therapy KW - Chemotherapy, Adjuvant KW - Breast Neoplasms -- Mortality KW - Female KW - Neoplasm Recurrence, Local KW - Serial Publications SP - 253 EP - 255 JO - Breast Journal JF - Breast Journal JA - BREAST J VL - 23 IS - 3 CY - Malden, Massachusetts PB - Wiley-Blackwell AB - An editorial is presented on the use of adjuvant chemotherapy for breast cancer in elderly women. It expresses the view that the improvement of life expectancy will drive the growth of the overall incidence of breast cancer, due to the increase in women 65 years or older. The challenges in addressing breast cancer mortality are noted, along tools to aid in the decision about selecting patients for adjuvant therapy. SN - 1075-122X AD - Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Albert Einstein Cancer Center DO - 10.1111/tbj.12730 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=123087690&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 123087684 T1 - Population-Based Study of Attitudes toward BRCA Genetic Testing among Orthodox Jewish Women. AU - Tang, Eve Y. AU - Trivedi, Meghna S. AU - Kukafka, Rita AU - Chung, Wendy K. AU - David, Raven AU - Respler, Leah AU - Leifer, Sarah AU - Schechter, Isaac AU - Crew, Katherine D. Y1 - 2017/05//May/Jun2017 N1 - Accession Number: 123087684. Language: English. Entry Date: 20170519. Revision Date: 20170522. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Peer Reviewed; USA. NLM UID: 9505539. KW - Genes, BRCA KW - Mutation KW - Genetic Screening KW - Breast Neoplasms -- Familial and Genetic KW - Human KW - Cross Sectional Studies KW - New York KW - Breast Neoplasms -- Risk Factors KW - Jews KW - Multivariate Analysis KW - Logistic Regression KW - Descriptive Statistics KW - Self-Efficacy SP - 333 EP - 337 JO - Breast Journal JF - Breast Journal JA - BREAST J VL - 23 IS - 3 CY - Malden, Massachusetts PB - Wiley-Blackwell AB - Given the high prevalence (1 in 40) of BRCA1 and BRCA2 mutations among Ashkenazi Jews, population-based BRCA genetic testing in this ethnic subgroup may detect more mutation carriers. We conducted a cross-sectional survey among Orthodox Jewish women in New York City to assess breast cancer risk, genetic testing knowledge, self-efficacy, perceived breast cancer risk and worry, religious and cultural factors affecting medical decision-making. We used descriptive statistics and multivariable logistic regression models to identify predictors of genetic testing intention/uptake. Among evaluable respondents ( n = 243, 53% response rate), median age was 25 and nearly half (43%) had a family history of breast cancer. Only 49% of the women had adequate genetic testing knowledge and 46% had accurate breast cancer risk perceptions. Five percent had already undergone BRCA genetic testing, 20% stated that they probably/definitely will get tested, 28% stated that they probably/definitely will not get tested, and 46% had not thought about it. High decision self-efficacy, adequate genetic testing knowledge, higher breast cancer risk, and overestimation of risk were associated with genetic testing intention/uptake. Decision support tools that improve knowledge and self-efficacy about genetic testing may facilitate population-based BRCA testing among Orthodox Jews. SN - 1075-122X AD - Weill Cornell Medicine, Cornell University AD - Columbia University Medical Center AD - Institute for Applied Research and Community Collaboration DO - 10.1111/tbj.12736 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=123087684&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 123188474 T1 - A qualitative study on a decision aid for breast cancer screening: Views from women and health professionals. AU - Toledo-Chávarri, A. AU - Rué, M. AU - Codern-Bové, N. AU - Carles-Lavila, M. AU - Perestelo-Pérez, L. AU - Pérez-Lacasta, M.J. AU - Feijoo-Cid, M. Y1 - 2017/05// N1 - Accession Number: 123188474. Language: English. Entry Date: 20170526. Revision Date: 20170527. Publication Type: Article; research; tables/charts. Journal Subset: Core Nursing; Europe; Nursing; Peer Reviewed; UK & Ireland. Grant Information: This study was supported by the research grant “Women participation in decisions and strategies on early detection of breast cancer” (PI14/00113) from the Instituto de Salud Carlos III and cofunded by Fondo Europeo de Desarrollo Regional (FEDER) “Una manera de hacer Europa”.. NLM UID: 9301979. KW - Breast Neoplasms KW - Cancer Screening KW - Decision Support Techniques KW - Human KW - Qualitative Studies KW - Female KW - Adult KW - Middle Age KW - Aged KW - Focus Groups KW - Content Analysis KW - Funding Source SP - n/a EP - n/a JO - European Journal of Cancer Care JF - European Journal of Cancer Care JA - EUR J CANCER CARE VL - 26 IS - 3 CY - Malden, Massachusetts PB - Wiley-Blackwell AB - This qualitative study evaluates a decision aid that includes the benefits and harms of breast cancer screening and analyses women's perception of the information received and healthcare professionals' perceptions of the convenience of providing it. Seven focus groups of women aged 40-69 years ( n = 39) and two groups of healthcare professionals ( n = 23) were conducted in Catalonia and the Canary Islands. The focus groups consisted of guided discussions regarding decision-making about breast cancer screening, and acceptability and feasibility of the decision aid. A content analysis was performed. Women positively value receiving information regarding the benefits and harms of breast cancer screening. Several women had difficulties understanding some concepts, especially those regarding overdiagnosis. Women preferred to share the decisions on screening with healthcare professionals. The professionals noted the lack of inclusion of some harms and benefits in the decision aid, and proposed improving the clarity of the statistical information. The information on overdiagnosis generates confusion among women and controversy among professionals. Faced with the new information presented by the decision aid, the majority of women prefer shared decision-making; however, its feasibility might be limited by a lack of knowledge and attitudes of rejection from healthcare professionals. SN - 0961-5423 AD - Canary Islands Foundation of Health Research (FUNCANIS) AD - Health Services Research on Chronic Patients Network (REDISSEC) AD - Basic Medical Sciences Department, University of Lleida-IRBLLEIDA AD - Research Group in Economic Analysis and Health (GRAES, 2014 SGR 978) AD - ÀreaQ, Evaluation and Qualitative Research AD - Escola Universitària d'Infermeria i Teràpia Ocupacional (EUIT), Terrassa Universitat Autónoma de Barcelona AD - Department of Economics and CREIP, Rovira i Virgili University (URV) AD - Evaluation Unit of the Canary Islands Health Service (SESCS) AD - Center for Biomedical Research of the Canary Islands (CIBICAN) AD - Department of Nursing, Faculty of Medicine, Universitat Autónoma de Barcelona AD - Researcher in Grups de Recerca d'America i Àfrica Llatines (GRAAL) (2014 SGR 1175) AD - Researcher Collaborator of the Infectious Diseases Group, Vall d'Hebron Institut de Recerca (VHIR) DO - 10.1111/ecc.12660 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=123188474&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 122456696 T1 - Discussing risk with patients. AU - Price, Bob Y1 - 2017/04/12/ N1 - Accession Number: 122456696. Language: English. Entry Date: 20170419. Revision Date: 20170419. Publication Type: Article; case study; CEU; tables/charts. Journal Subset: Double Blind Peer Reviewed; Europe; Expert Peer Reviewed; Nursing; Peer Reviewed; UK & Ireland. NLM UID: 9012906. KW - Risk Assessment KW - Decision Making, Patient KW - Risk Factors KW - Education, Continuing (Credit) KW - Patient Education KW - Nursing Practice KW - Ethics, Nursing KW - Female KW - Male KW - Adult KW - Decision Making, Clinical KW - Adolescence KW - Patient Attitudes KW - Genetic Screening KW - Breast Neoplasms -- Risk Factors KW - Smoking KW - Food Hypersensitivity SP - 53 EP - 62 JO - Nursing Standard JF - Nursing Standard JA - NURS STAND VL - 31 IS - 33 PB - RCNi AB - Nurses support patients to make decisions about risk on a regular basis. They aim to offer patients evidence regarding the choices available. However, it is necessary for patients to understand the components of risk and associated decisions, before shared decisionmaking can be realised. This article provides a straightforward explanation of risk and risk decision-making to enable nurses to support patients through the risk-assessment process. Consideration is given to the patient's predisposition towards risk, whether positive or negative, and the necessity of reviewing the patient's understanding of the risks involved. A model of risk assessment is presented, that considers the likelihood of a risk occurring and its possible effects on the patient. The article emphasises the importance of considering risk decisions in the long term, including the opportunities that are realised with each decision made. Case studies are used to consider these principles in practice. SN - 0029-6570 DO - 10.7748/ns.2017.e10646 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=122456696&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 121935044 T1 - Clinical use of biomarkers in breast cancer: Updated guidelines from the European Group on Tumor Markers (EGTM). AU - Duffy, M.J. AU - Harbeck, N. AU - Nap, M. AU - Molina, R. AU - Nicolini, A. AU - Senkus, E. AU - Cardoso, F. Y1 - 2017/04// N1 - Accession Number: 121935044. Language: English. Entry Date: 20170330. Revision Date: 20170330. Publication Type: Article. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. NLM UID: 9005373. KW - Breast Neoplasms KW - Practice Guidelines -- Europe KW - Tumor Markers, Biological KW - Lymph Nodes KW - Prognosis KW - Receptors, Estrogen KW - Receptors, Progesterone KW - Europe KW - Antineoplastic Agents KW - Decision Making, Clinical SP - 284 EP - 298 JO - European Journal of Cancer JF - European Journal of Cancer JA - EUR J CANCER VL - 75 PB - Pergamon Press - An Imprint of Elsevier Science AB - Biomarkers play an essential role in the management of patients with invasive breast cancer. For selecting patients likely to respond to endocrine therapy, both oestrogen receptors (ERs) and progesterone receptors (PRs) should be measured on all newly diagnosed invasive breast cancers. On the other hand, for selecting likely response to all forms of anti-HER2 therapy (trastuzumab, pertuzumab, lapatinib or ado-trastuzumab emtansine), determination of HER2 expression or gene copy number is mandatory. Where feasible, measurement of ER, PR and HER2 should be performed on recurrent lesions and the primary invasive tumour. Although methodological problems exist in the determination of Ki67, because of its clearly established clinical value, wide availability and low costs relative to the available multianalyte signatures, Ki67 may be used for determining prognosis, especially if values are low or high. In oestrogen receptor (ER)-positive, HER2-negative, lymph node–negative patients, multianalyte tests such as urokinase plasminogen activator (uPA)-PAI-1, Oncotype DX, MammaPrint, EndoPredict, Breast Cancer Index (BCI) and Prosigna (PAM50) may be used to predict outcome and aid adjunct therapy decision-making. Oncotype DX, MammaPrint, EndoPredict and Prosigna may be similarly used in patients with 1–3 metastatic lymph nodes. All laboratories measuring biomarkers for patient management should use analytically and clinically validated assays, participate in external quality assurance programs, have established assay acceptance and rejection criteria, perform regular audits and be accredited by an appropriate organisation. SN - 0959-8049 AD - Clinical Research Centre, St. Vincent's University Hospital, Dublin and UCD School of Medicine, UCD Conway Institute, University College Dublin, Dublin 4, Ireland AD - Breast Center of the University of Munich, Munich, Germany AD - Department of Pathology, Atrium Heerlen Medical Centre, Heerlen, The Netherlands AD - Laboratory of Biochemistry, Hospital Clinic, Barcelona, Spain AD - Department of Oncology, Transplantations and New Technologies in Medicine, University of Pisa, Pisa, Italy AD - Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland AD - Breast Unit, Champalimaud Clinical Centre, Lisbon, Portugal DO - 10.1016/j.ejca.2017.01.017 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=121935044&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 123563940 T1 - Learning Healthcare System for the Prescription of Genetic Testing in the Gynecological Cancer Risk..."Informatics for Health," Manchester, UK, April 2017 AU - SUÁREZ-MEJÍAS, Cristina AU - MARTÍNEZ-GARCÍA, Alicia AU - MARTÍNEZ-MAESTRE, María Ángeles AU - SILVAN-ALFARO, José Manuel AU - MORENO CONDE, Jesús AU - PARRA-CALDERÓN, Carlos Luis Y1 - 2017/04// N1 - Accession Number: 123563940. Language: English. Entry Date: 20170626. Revision Date: 20170626. Publication Type: Article; tables/charts. Journal Subset: Computer/Information Science; Continental Europe; Editorial Board Reviewed; Europe; Peer Reviewed. NLM UID: 9214582. KW - Genetic Screening KW - Genital Diseases, Female -- Diagnosis KW - Decision Support Systems, Clinical KW - Breast Neoplasms -- Diagnosis KW - Congresses and Conferences -- United Kingdom KW - United Kingdom KW - Genes, BRCA KW - Mutation KW - Systems Design SP - 96 EP - 100 JO - Studies in Health Technology & Informatics JF - Studies in Health Technology & Informatics JA - STUD HEALTH TECHNOL INFORM VL - 235 PB - IOS Press AB - Clinical evidence demonstrates that BRCA 1 and BRCA2 mutations can develop a gynecological cancer but genetic testing has a high cost to the healthcare system. Besides, several studies in the literature indicate that performing these genetic tests to the population is not cost-efficient. Currently, our physicians do not have a system to provide them the support for prescribing genetic tests. A Decision Support System for prescribing these genetic tests in BRCA1 and BRCA2 and preventing gynecological cancer risks has been designed, developed and deployed in the Virgen del Rocío University Hospital (VRUH). The technological architecture integrates a set of open source tools like Mirth Connect, OpenClinica, OpenCDS, and tranSMART in addition to several interoperability standards. The system allows general practitioners and gynecologists to classify patients as low risk (they do not require a specific treatment) or high risk (they should be attended by the Genetic Council). On the other hand, by means of this system we are also able to standardize criteria among professionals to prescribe these genetic tests. Finally, this system will also contribute to improve the assistance for this kind of patients. SN - 0926-9630 AD - Group of Research and Innovation in Biomedical informatics, biomedical engineer and health economy. Institute of Biomedicine of Seville, IBiS/"Virgen del Rocío" University Hospital/CSIC/University of Seville. Seville, Spain AD - Gynecology Department, Virgen del Rocío University Hospital, Seville, Spain DO - 10.3233/978-1-61499-753-5-96 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=123563940&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 122026591 T1 - Facilitating informed decisions about breast cancer screening: development and evaluation of a web-based decision aid for women in their 40s. AU - Elkin, Elena B. AU - Pocus, Valerie H. AU - Mushlin, Alvin I. AU - Cigler, Tessa AU - Atoria, Coral L. AU - Polaneczky, Margaret M. Y1 - 2017/03/21/ N1 - Accession Number: 122026591. Language: English. Entry Date: In Process. Revision Date: 20171231. Publication Type: journal article; clinical trial; research. Journal Subset: Biomedical; Computer/Information Science; Europe; UK & Ireland. Special Interest: Evidence-Based Practice. Instrumentation: Perceived Stress Scale (PSS) (Cohen et al). Grant Information: P30 CA008748/CA/NCI NIH HHS/United States. NLM UID: 101088682. KW - Attitude to Health KW - Internet KW - Breast Neoplasms -- Prevention and Control KW - Health Behavior KW - Decision Support Techniques KW - Breast Neoplasms KW - Adult KW - Middle Age KW - Human KW - Female KW - Pilot Studies KW - Clinical Trials KW - Validation Studies KW - Comparative Studies KW - Evaluation Research KW - Multicenter Studies KW - Scales SP - 1 EP - 9 JO - BMC Medical Informatics & Decision Making JF - BMC Medical Informatics & Decision Making JA - BMC MED INFORM DECIS MAKING VL - 17 PB - BioMed Central AB - Background: Expert groups and national guidelines recommend individualized decision making about screening mammography for women in their 40s at low-to-average risk of breast cancer. We created Breast Screening Decisions (BSD), a personalized, web-based decision aid, to help women decide when to start and how often to have routine screening mammograms. We evaluated BSD in a large, prospective pilot trial of women and their clinicians.Methods: Women ages 40-49 were invited to use BSD before a scheduled preventive care visit. One month post-visit, users were asked about decisional conflict, knowledge, perceptions and worry about breast cancer and screening. They were also asked whether they had a screening mammogram since their visit, scheduled an appointment for a screening mammogram, or if they were planning to schedule an appointment within the next six months. Women who responded "no" to each of these successive questions were considered to have no plan for a screening mammogram within the next 6 months, unless they explicitly stated that they were unsure about screening mammography. Clinicians were surveyed regarding mammography discussions and perceived patient knowledge and anxiety.Results: Of 1,100 women invited to use BSD, 253 accessed the website, and 168 were eligible to participate in the pilot study. One-fifth had a family history of breast cancer, and at least 76% had any prior mammogram. At follow-up, 88% of BSD users reported discussing mammography at their visit, and 77% said they had a screening mammogram since the visit or that they made or were planning to make a screening mammogram appointment. The average decisional conflict score was 22.5, within the threshold for implementing decisions. Decisional conflict scores were lowest in women who said that they had or planned to have a mammogram (mean 21.4, 95% CI 18.3-24.6), higher in those who did not (mean 24.8, 95% CI 19.2-30.5), and highest in those who were unsure (mean 31.5, 95% CI 13.9-49.1). Most BSD users expressed accurate perceptions of their breast cancer risk and the benefits and limitations of screening.Conclusions: A web-based decision aid may support informed, individualized decisions about screening mammography and facilitate discussions about screening between women in their 40s and their clinicians. SN - 1472-6947 AD - Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA AD - Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA AD - Department of Medicine, Weill Cornell Medical College, New York, NY, USA AD - Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA U2 - PMID: 28327125. DO - 10.1186/s12911-017-0423-7 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=122026591&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 123173959 T1 - A case-based reasoning system based on weighted heterogeneous value distance metric for breast cancer diagnosis. AU - Gu, Dongxiao AU - Liang, Changyong AU - Zhao, Huimin Y1 - 2017/03// N1 - Accession Number: 123173959. Language: English. Entry Date: 20171129. Revision Date: 20171208. Publication Type: journal article. Journal Subset: Biomedical; Blind Peer Reviewed; Computer/Information Science; Continental Europe; Europe; Expert Peer Reviewed; Peer Reviewed. Instrumentation: Learning and Study Strategies Inventory (LASSI). NLM UID: 8915031. KW - Decision Support Techniques KW - Breast Neoplasms KW - Expert Systems KW - Female KW - ROC Curve KW - Algorithms KW - Software SP - 31 EP - 47 JO - Artificial Intelligence in Medicine JF - Artificial Intelligence in Medicine JA - ARTIF INTELL MED VL - 77 PB - Elsevier B.V. AB - Objective: We present the implementation and application of a case-based reasoning (CBR) system for breast cancer related diagnoses. By retrieving similar cases in a breast cancer decision support system, oncologists can obtain powerful information or knowledge, complementing their own experiential knowledge, in their medical decision making.Methods: We observed two problems in applying standard CBR to this context: the abundance of different types of attributes and the difficulty in eliciting appropriate attribute weights from human experts. We therefore used a distance measure named weighted heterogeneous value distance metric, which can better deal with both continuous and discrete attributes simultaneously than the standard Euclidean distance, and a genetic algorithm for learning the attribute weights involved in this distance measure automatically. We evaluated our CBR system in two case studies, related to benign/malignant tumor prediction and secondary cancer prediction, respectively.Result: Weighted heterogeneous value distance metric with genetic algorithm for weight learning outperformed several alternative attribute matching methods and several classification methods by at least 3.4%, reaching 0.938, 0.883, 0.933, and 0.984 in the first case study, and 0.927, 0.842, 0.939, and 0.989 in the second case study, in terms of accuracy, sensitivity×specificity, F measure, and area under the receiver operating characteristic curve, respectively.Conclusion: The evaluation result indicates the potential of CBR in the breast cancer diagnosis domain. SN - 0933-3657 AD - School of Management, Hefei University of Technology, 193 Tunxi Road, Hefei, Anhui, 230009, China AD - Sheldon B. Lubar School of Business, University of Wisconsin-Milwaukee, 3202 North Maryland Avenue, Milwaukee, WI, 53201, USA U2 - PMID: 28545610. DO - 10.1016/j.artmed.2017.02.003 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=123173959&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 121754375 T1 - Effect of a decision aid with patient narratives in reducing decisional conflict in choice for surgery among early-stage breast cancer patients: A three-arm randomized controlled trial. AU - Osaka, Wakako AU - Nakayama, Kazuhiro Y1 - 2017/03// N1 - Accession Number: 121754375. Language: English. Entry Date: In Process. Revision Date: 20170318. Publication Type: journal article. Journal Subset: Core Nursing; Europe; Health Promotion/Education; Nursing; Peer Reviewed; UK & Ireland. NLM UID: 8406280. SP - 550 EP - 562 JO - Patient Education & Counseling JF - Patient Education & Counseling JA - PATIENT EDUC COUNS VL - 100 IS - 3 PB - Elsevier B.V. AB - Objective: We aimed to evaluate the effect of a decision aid (DA) with patient narratives on decisional conflict in surgery choice for Japanese women with early-stage breast cancer.Methods: Two hundred ten women with early-stage breast cancer were randomly assigned to an intervention or control group. Groups 1 and 2 received standard information and a DA, with or without patient narratives, and Group 3 received standard information (control) before surgery choice. At baseline, post-intervention (Time 2), and 1 month after surgery (Time 3), we evaluated decisional conflict as the primary outcome using a decisional conflict scale (DCS). Sidak corrections for multiple comparisons in analysis of covariate were used to compare Time 2 and Time 3 DCS mean scores between each pair of groups.Results: At Time 3, decisional conflict was significantly reduced for Group 1 vs control (P=0.021, Cohen's d =0.26) and Group 2 vs control (P=0.008, Cohen's d=0.40).Conclusion: The DAs with and without patient narratives are equivalently effective at reducing postoperative decisional conflict in Japanese women with early-stage breast cancer.Practice Implications: The DAs with and without patient narratives can be used in clinical practice for women with early-stage breast cancer. SN - 0738-3991 AD - Department of Nursing Informatics, St. Luke’s International University Graduate School of Nursing Science, Tokyo, Japan AD - School of Nursing, The Jikei University, Tokyo, Japan U2 - PMID: 28277290. DO - 10.1016/j.pec.2016.09.011 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=121754375&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 121091794 T1 - Harnessing Breast Cancer Data to Generate Positive Outcomes. AU - KAHLON, SUMMERPAL Y1 - 2017/02/10/ N1 - Accession Number: 121091794. Language: English. Entry Date: 20170219. Revision Date: 20170219. Publication Type: Article; pictorial. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 8100849. KW - Breast Neoplasms -- Prevention and Control KW - Health Knowledge KW - Decision Making, Clinical KW - Health Literacy KW - Health Information Systems KW - Technology, Medical KW - Database Construction KW - Data Analytics SP - 16 EP - 16 JO - Oncology Times JF - Oncology Times JA - ONCOL TIMES VL - 39 IS - 3 CY - Baltimore, Maryland PB - Lippincott Williams & Wilkins SN - 0276-2234 AD - Staff at the Orlando VA Medical Center AD - Assistant Professor of Medicine, University of Central Florida College of Medicine UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=121091794&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 121173649 T1 - 199 - A decision aid for curatively treated breast cancer patients to effectively individualize the aftercare, improve shared decision making, and reduce costs...ECCO: 2017 European Cancer Congress 27 January 2017 - 30 January 2017 AU - Klaassen, L. AU - Hoving, C. AU - Boersma, L. AU - Dirksen, C. Y1 - 2017/02/02/Feb2017 Supplement 1 N1 - Accession Number: 121173649. Language: English. Entry Date: 20170217. Revision Date: 20170217. Publication Type: Article; abstract; research. Supplement Title: Feb2017 Supplement 1. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. Special Interest: Women's Health. NLM UID: 9005373. KW - After Care KW - Decision Support Techniques KW - Cost Savings -- Methods KW - Breast Neoplasms -- Therapy KW - Cancer Survivors KW - Human KW - Female KW - Women's Health KW - Decision Making, Patient KW - Decision Making, Clinical KW - Individualized Medicine SP - S22 EP - S22 JO - European Journal of Cancer JF - European Journal of Cancer JA - EUR J CANCER VL - 72 PB - Pergamon Press - An Imprint of Elsevier Science SN - 0959-8049 DO - 10.1016/S0959-8049(17)30151-X UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=121173649&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 121071822 T1 - Tracing a Path to the Past: Exploring the Use of Commercial Credit Reporting Data to Construct Residential Histories for Epidemiologic Studies of Environmental Exposures. AU - Hurley, Susan AU - Hertz, Andrew AU - Nelson, David O. AU - Layefsky, Michael AU - Von Behren, Julie AU - Bernstein, Leslie AU - Deapen, Dennis AU - Reynolds, Peggy Y1 - 2017/02//2/1/2017 N1 - Accession Number: 121071822. Language: English. Entry Date: 20170221. Revision Date: 20170221. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; Public Health; USA. Grant Information: This research was supported by funding from the Regents of the University of California Breast Cancer Research Program (grant 16ZB-8501) and the National Cancer Institute, National Institutes of Health (grants R01CA170394 and R01CA77398).. NLM UID: 7910653. KW - Credit -- Statistics and Numerical Data -- California KW - Data Analytics KW - Access to Information KW - Breast Neoplasms KW - Human KW - Female KW - Pilot Studies KW - California KW - Cancer Patients -- Statistics and Numerical Data KW - Geographic Information Systems KW - Young Adult KW - Adult KW - Middle Age KW - Aged KW - Aged, 80 and Over KW - Race Factors KW - Age Factors KW - Chi Square Test KW - P-Value KW - Data Analysis Software KW - Funding Source SP - 238 EP - 246 JO - American Journal of Epidemiology JF - American Journal of Epidemiology JA - AM J EPIDEMIOL VL - 185 IS - 3 PB - Oxford University Press / USA AB - Large-scale environmental epidemiologic studies often rely on exposure estimates based on linkage to residential addresses. This approach, however, is limited by the lack of residential histories typically available for study participants. Our objective was to evaluate the feasibility of using address data from LexisNexis (a division of RELX, Inc., Dayton, Ohio), a commercially available credit reporting company, to construct residential histories for participants in the California Teachers Study (CTS), a prospective cohort study initiated in 1995-1996 to study breast cancer (n = 133,479). We evaluated the degree to which LexisNexis could provide retrospective addresses prior to study enrollment, as well as the concordance with existing prospective CTS addresses ascertained at the time of the completion of 4 self-administered questionnaires. For approximately 80% of CTS participants, LexisNexis provided at least 1 retrospective address, including nearly 25,000 addresses completely encompassed by time periods prior to enrollment. This approach more than doubled the proportion of the study population for whom we had an address of residence during the childbearing years--an important window of susceptibility for breast cancer risk. While overall concordance between the prospective addresses contained in these 2 data sources was good (85%), it was diminished among black women and women under the age of 40 years. SN - 0002-9262 AD - Cancer Prevention Institute of California, Berkeley, California AD - Department of Population Sciences, Division of Cancer Etiology, Beckman Research Institute of the City of Hope, Duarte, California AD - Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California AD - Department of Health Research and Policy, Division of Epidemiology, School of Medicine, Stanford University, Stanford, California DO - 10.1093/aje/kww108 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=121071822&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 121710555 T1 - Prediction of Trastuzumab Benefit in HER2-Positive Breast Cancers: Is It in the Intrinsic Subtype? AU - Kim, Jisun AU - Pareja, Fresia AU - Weigelt, Britta AU - Reis-Filho, Jorge S. Y1 - 2017/02// N1 - Accession Number: 121710555. Language: English. Entry Date: In Process. Revision Date: 20170411. Publication Type: journal article. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 7503089. SP - 1 EP - 2 JO - JNCI: Journal of the National Cancer Institute JF - JNCI: Journal of the National Cancer Institute JA - J NATL CANCER INST VL - 109 IS - 2 PB - Oxford University Press / USA AB - An editorial is presented which argues on the benefits of trastuzumab in treating HER-2 positive breast cancer. Topics discussed include testing the addition of trastuzumab in chemotherapy receiving patients, intrinsic subtyping in guiding treatment decision making and risk analysis in relapse free survival using gene expression data. SN - 0027-8874 AD - Affiliation of authors: Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY U2 - PMID: 28376223. DO - 10.1093/jnci/djw218 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=121710555&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 120895338 T1 - Medical Image Retrieval Using Vector Quantization and Fuzzy S-tree. AU - Nowaková, Jana AU - Prílepok, Michal AU - Snášel, Václav Y1 - 2017/02// N1 - Accession Number: 120895338. Language: English. Entry Date: 20170202. Revision Date: 20170202. Publication Type: Article; algorithm; equations & formulas; research; tables/charts. Journal Subset: Computer/Information Science; Continental Europe; Europe; Peer Reviewed. Special Interest: Oncologic Care; Women's Health. Grant Information: This work was supported by the Czech Science Foundation under grant No. GACR GJ16-25694Y and in part by the grant of SGS No. SP2016/68 VSB - Technical University of Ostrava, Czech Republic.. NLM UID: 7806056. KW - Image Retrieval -- Methods KW - Image Retrieval Systems KW - Mammography KW - Breast Neoplasms -- Diagnosis KW - Decision Support Systems, Clinical KW - Radiographic Image Interpretation, Computer-Assisted KW - Algorithms KW - Magnetic Resonance Imaging KW - Female KW - Women's Health KW - Human KW - Funding Source KW - Czech Republic KW - Databases KW - Sensitivity and Specificity KW - False Positive Results KW - False Negative Results KW - Validity KW - Descriptive Statistics KW - Mammography -- Classification SP - 1 EP - 16 JO - Journal of Medical Systems JF - Journal of Medical Systems JA - J MED SYST VL - 41 IS - 2 CY - , PB - Springer Science & Business Media B.V. AB - The aim of the article is to present a novel method for fuzzy medical image retrieval (FMIR) using vector quantization (VQ) with fuzzy signatures in conjunction with fuzzy S-trees. In past times, a task of similar pictures searching was not based on searching for similar content (e.g. shapes, colour) of the pictures but on the picture name. There exist some methods for the same purpose, but there is still some space for development of more efficient methods. The proposed image retrieval system is used for finding similar images, in our case in the medical area - in mammography, in addition to the creation of the list of similar images - cases. The created list is used for assessing the nature of the finding - whether the medical finding is malignant or benign. The suggested method is compared to the method using Normalized Compression Distance (NCD) instead of fuzzy signatures and fuzzy S-tree. The method with NCD is useful for the creation of the list of similar cases for malignancy assessment, but it is not able to capture the area of interest in the image. The proposed method is going to be added to the complex decision support system to help to determine appropriate healthcare according to the experiences of similar, previous cases. SN - 0148-5598 AD - Faculty of Electrical Engineering and Computer Science, Department of Computer Science , VŠB - Technical University of Ostrava , 17. listopadu 15/2172 708 33 Ostrava - Poruba Czech Republic DO - 10.1007/s10916-016-0659-2 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=120895338&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 121218656 T1 - Cost Comparison of Genetic Testing Strategies in Women With Epithelial Ovarian Cancer. AU - Foote, Jonathan R. AU - Lopez-Acevedo, Micael AU - Buchanan, Adam H. AU - Alvarez Secord, Angeles AU - Lee, Paula S. AU - Fountain, Cynthia AU - Myers, Evan R. AU - Cohn, David E. AU - Reed, Shelby D. AU - Havrilesky, Laura J. Y1 - 2017/02// N1 - Accession Number: 121218656. Language: English. Entry Date: 20170215. Revision Date: 20170218. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; USA. Special Interest: Women's Health. NLM UID: 101261852. KW - Genetic Screening -- Economics KW - Neoplasms, Glandular and Epithelial -- Familial and Genetic KW - Ovarian Neoplasms -- Familial and Genetic KW - Genes, BRCA KW - Genetic Screening -- Methods KW - Breast Neoplasms -- Familial and Genetic KW - Female KW - Family History KW - Human KW - Mutation KW - Risk Factors KW - Decision Support Techniques SP - e120 EP - e129 JO - Journal of Oncology Practice JF - Journal of Oncology Practice JA - J ONCOL PRACT VL - 13 IS - 2 CY - Alexandria, Virginia PB - American Society of Clinical Oncology AB - Purpose The advent of multigene panels has increased genetic testing options for women with epithelial ovarian cancer (EOC). We designed a decision model to compare costs and probabilities of identifying a deleterious mutation or variant of uncertain significance (VUS) using different genetic testing strategies. Methods A decision model was developed to compare costs and outcomes of two testing strategies for women with EOC: multigene testing (MGT) versus single-gene testing for BRCA1/2. Outcomes were mean cost and number of deleterious mutations and VUSs identified. Model inputs were obtained from published genetic testing data in EOC. One-way sensitivity analyses and Monte Carlo probabilistic sensitivity analyses were performed. Results No family history model: MGT cost $1,160 more on average than BRCA1/2 testing and identified an additional 3.8 deleterious mutations for every 100 women tested. For each additional deleterious mutation identified, MGT cost $30,812 and identified 5.4 additional VUSs. Family history model: MGT cost $654 more on average and identified an additional 7.0 deleterious mutations for every 100 women tested. For each additional deleterious mutation identified, MGT cost $9,909 and identified 2.6 additional VUSs. Conclusion MGT was associated with a higher additional cost per deleterious mutation identified anda higher ratio of VUS burden to actionable information in women with no family history as compared with women with a family history. Family history should be considered when determining an initial genetic testing platform in women with EOC. SN - 1554-7477 AD - Duke University Medical Center, Durham, NC; and Ohio State University Medical Center, Columbus, OH DO - 10.1200/JOP.2016.011866 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=121218656&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 120687586 T1 - Persuasive Interventions for Controversial Cancer Screening Recommendations: Testing a Novel Approach to Help Patients Make Evidence-Based Decisions. AU - Saver, Barry G. AU - Mazor, Kathleen M. AU - Luckmann, Roger AU - Cutrona, Sarah L. AU - Hayes, Marcela AU - Gorodetsky, Tatyana AU - Esparza, Nancy AU - Bacigalupe, Gonzalo Y1 - 2017/01//Jan/Feb2017 N1 - Accession Number: 120687586. Language: English. Entry Date: 20171117. Revision Date: 20171117. Publication Type: journal article; research; randomized controlled trial. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Evidence-Based Practice. Instrumentation: Work Environment Scale (WES) (Moos et al). NLM UID: 101167762. KW - Persuasive Communication KW - Early Detection of Cancer -- Methods KW - Breast Neoplasms -- Diagnosis KW - Decision Making KW - Prostatic Neoplasms -- Diagnosis KW - Consumer Participation KW - Crossover Design KW - Mammography KW - Aged KW - Decision Support Techniques KW - Male KW - Female KW - Human KW - United States KW - Middle Age KW - Videorecording KW - Adult KW - Validation Studies KW - Comparative Studies KW - Evaluation Research KW - Multicenter Studies KW - Randomized Controlled Trials KW - Scales SP - 48 EP - 55 JO - Annals of Family Medicine JF - Annals of Family Medicine JA - ANN FAM MED VL - 15 IS - 1 CY - Skokie, Illinois PB - Annals of Family Medicine AB - Purpose: We wanted to evaluate novel decision aids designed to help patients trust and accept the controversial, evidence-based, US Preventive Services Task Force recommendations about prostate cancer screening (from 2012) and mammography screening for women aged 40 to 49 years (from 2009).Methods: We created recorded vignettes of physician-patient discussions about prostate cancer screening and mammography, accompanied by illustrative slides, based on principles derived from preceding qualitative work and behavioral science literature. We conducted a randomized crossover study with repeated measures with 27 men aged 50 to 74 years and 35 women aged 40 to 49 years. All participants saw a video intervention and a more traditional, paper-based decision aid intervention in random order. At entry and after seeing each intervention, they were surveyed about screening intentions, perceptions of benefits and harm, and decisional conflict.Results: Changes in screening intentions were analyzed without regard to order of intervention after an initial analyses showed no evidence of an order effect. At baseline, 69% of men and 86% of women reported wanting screening, with 31% and 6%, respectively, unsure. Mean change on a 3-point, yes, unsure, no scale was -0.93 (P = <.001) for men and -0.50 (P = <.001) for women after seeing the video interventions vs 0.0 and -0.06 (P = .75) after seeing the print interventions. At the study end, 33% of men and 49% of women wanted screening, and 11% and 20%, respectively, were unsure.Conclusions: Our novel, persuasive video interventions significantly changed the screening intentions of substantial proportions of viewers. Our approach needs further testing but may provide a model for helping patients to consider and accept evidence-based, counterintuitive recommendations. SN - 1544-1709 AD - University of Massachusetts Medical School, Worcester, Massachusetts AD - Meyers Primary Care Research Institute, Worcester, Massachusetts AD - Swedish Family Medicine Residency Cherry Hill, Seattle, Washington AD - Veterans Health Administration, HSRD COIN Edith Nourse Rogers Memorial Hospitalo, Bedford, Massachusetts AD - Center for Health Impact, Worcester, Massachusetts AD - University of Massachusetts, Boston, Massachusetts U2 - PMID: 28376460. DO - 10.1370/afm.1996 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=120687586&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 120262651 T1 - Correlating mammographic and pathologic findings in clinical decision support using natural language processing and data mining methods. AU - Patel, Tejal A. AU - Puppala, Mamta AU - Ogunti, Richard O. AU - Ensor, Joe E. AU - He, Tiancheng AU - Shewale, Jitesh B. AU - Ankerst, Donna P. AU - Kaklamani, Virginia G. AU - Rodriguez, Angel A. AU - Wong, Stephen T. C. AU - Chang, Jenny C. Y1 - 2017/01// N1 - Accession Number: 120262651. Language: English. Entry Date: 20170601. Revision Date: 20180101. Publication Type: journal article. Journal Subset: Biomedical; Peer Reviewed; USA. Instrumentation: Clinical Decision Making in Nursing Scale (CDMNS) (Jenkins). NLM UID: 0374236. KW - Breast Neoplasms -- Pathology KW - Breast Neoplasms -- Metabolism KW - Decision Support Systems, Clinical KW - Data Mining -- Methods KW - Software KW - Natural Language Processing KW - Receptors, Cell Surface -- Metabolism KW - Middle Age KW - Algorithms KW - Mammography -- Methods KW - Proteins -- Metabolism KW - Scales SP - 114 EP - 121 JO - Cancer (0008543X) JF - Cancer (0008543X) JA - CANCER VL - 123 IS - 1 CY - Hoboken, New Jersey PB - John Wiley & Sons, Inc. AB - Background: A key challenge to mining electronic health records for mammography research is the preponderance of unstructured narrative text, which strikingly limits usable output. The imaging characteristics of breast cancer subtypes have been described previously, but without standardization of parameters for data mining.Methods: The authors searched the enterprise-wide data warehouse at the Houston Methodist Hospital, the Methodist Environment for Translational Enhancement and Outcomes Research (METEOR), for patients with Breast Imaging Reporting and Data System (BI-RADS) category 5 mammogram readings performed between January 2006 and May 2015 and an available pathology report. The authors developed natural language processing (NLP) software algorithms to automatically extract mammographic and pathologic findings from free text mammogram and pathology reports. The correlation between mammographic imaging features and breast cancer subtype was analyzed using one-way analysis of variance and the Fisher exact test.Results: The NLP algorithm was able to obtain key characteristics for 543 patients who met the inclusion criteria. Patients with estrogen receptor-positive tumors were more likely to have spiculated margins (P = .0008), and those with tumors that overexpressed human epidermal growth factor receptor 2 (HER2) were more likely to have heterogeneous and pleomorphic calcifications (P = .0078 and P = .0002, respectively).Conclusions: Mammographic imaging characteristics, obtained from an automated text search and the extraction of mammogram reports using NLP techniques, correlated with pathologic breast cancer subtype. The results of the current study validate previously reported trends assessed by manual data collection. Furthermore, NLP provides an automated means with which to scale up data extraction and analysis for clinical decision support. Cancer 2017;114-121. © 2016 American Cancer Society. SN - 0008-543X AD - Houston Methodist Cancer Center AD - Cancer Research Program, Houston Methodist Research Institute AD - Department of Medicine, Weill Cornell Medicine AD - Department of Informatics Development, Houston Methodist Hospital AD - Department of Systems Medicine and Bioengineering, Houston Methodist Research Institute AD - Department of Epidemiology, Human Genetics & Environmental Sciences, University of Texas School of Public Health, Houston, Texas AD - Department of Urology, University of Texas Health Science Center at San Antonio AD - Department of Mathematics, Technical University of Munich AD - Division of Hematology Oncology CTRC, University of Texas Health Science Center San Antonio, San Antonio, Texas AD - Department of Radiology, Neurology, and Neuroscience, Weill Cornell Medicine AD - Department of Pathology and Laboratory Medicine, Weill Cornell Medicine U2 - PMID: 27571243. DO - 10.1002/cncr.30245 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=120262651&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 119923106 T1 - Mapping the Decision-Making Process for Adjuvant Endocrine Therapy for Breast Cancer. AU - Beryl, Louise L. AU - Rendle, Katharine A. S. AU - Halley, Meghan C. AU - Gillespie, Katherine A. AU - May, Suepattra G. AU - Glover, Jennifer AU - Yu, Peter AU - Chattopadhyay, Runi AU - Frosch, Dominick L. Y1 - 2017/01// N1 - Accession Number: 119923106. Language: English. Entry Date: In Process. Revision Date: 20161205. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 8109073. SP - 79 EP - 90 JO - Medical Decision Making JF - Medical Decision Making JA - MED DECIS MAKING VL - 37 IS - 1 CY - Thousand Oaks, California PB - Sage Publications Inc. AB - Background. Studies show adjuvant endocrine therapy increases survival and decreases risk of breast cancer recurrence for hormone receptor–positive tumors. Yet studies also suggest that adherence rates among women taking this therapy may be as low as 50% owing largely to adverse side effects. Despite these rates, research on longitudinal patient decision making regarding this therapy is scant. Objective. We sought to map the decision-making process for women considering and initiating adjuvant endocrine therapy, paying particular attention to patterns of uncertainty and decisional change over time. Methods. A longitudinal series of semistructured interviews conducted at a multispecialty health care organization in Northern California with 35 newly diagnosed patients eligible for adjuvant endocrine therapy were analyzed. Analysis led to the identification and indexing of 3 new decision-making constructs—decisional phase, decisional direction, and decisional resolve—which were then organized using a visual matrix and examined for patterns characterizing the decision-making process. Results. Our data reveal that most patients do not make a single, discrete decision to take or not take hormone therapy but rather traverse multiple decisional states, characterized by 1) phase, 2) direction, and 3) strength of resolve. Our analysis tracks these decisional states longitudinally using a grayscale-coded matrix. Our data show that decisional resolve wavers not just when considering therapy, as the existing concept of decisional conflict suggests, but even after initiating it, which may signal future decisions to forgo therapy. Conclusions. Adjuvant endocrine therapy, like other chronic care decisions, has a longer decision-making process and implementation period. Thus, theoretical, empirical, and clinical approaches should consider further exploring the new concept and measurement of decisional resolve, as it may help to improve subsequent medication adherence. SN - 0272-989X AD - Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA (LLB, KASR, MCH, KAG, SGM, JG, PY, RC, DLF) DO - 10.1177/0272989X16640488 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=119923106&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 120348784 T1 - Computational prediction of multidisciplinary team decision-making for adjuvant breast cancer drug therapies: a machine learning approach. AU - Lin, Frank P Y AU - Pokorny, Adrian AU - Teng, Christina AU - Dear, Rachel AU - Epstein, Richard J Y1 - 2016/12//12/1/2016 N1 - Accession Number: 120348784. Language: English. Entry Date: In Process. Revision Date: 20171128. Publication Type: journal article. Journal Subset: Biomedical; Europe; UK & Ireland. Instrumentation: Clinical Decision Making in Nursing Scale (CDMNS) (Jenkins). NLM UID: 100967800. KW - Models, Theoretical KW - Antineoplastic Agents, Combined -- Therapeutic Use KW - Breast Neoplasms -- Drug Therapy KW - Multidisciplinary Care Team KW - Breast Neoplasms -- Diagnosis KW - Combined Modality Therapy KW - Middle Age KW - Aged, 80 and Over KW - Algorithms KW - Female KW - Aged KW - Adult KW - Computer Simulation KW - Chemotherapy, Adjuvant KW - Scales SP - 929 EP - 929 JO - BMC Cancer JF - BMC Cancer JA - BMC CANCER VL - 16 PB - BioMed Central AB - Background: Multidisciplinary team (MDT) meetings are used to optimise expert decision-making about treatment options, but such expertise is not digitally transferable between centres. To help standardise medical decision-making, we developed a machine learning model designed to predict MDT decisions about adjuvant breast cancer treatments.Methods: We analysed MDT decisions regarding adjuvant systemic therapy for 1065 breast cancer cases over eight years. Machine learning classifiers with and without bootstrap aggregation were correlated with MDT decisions (recommended, not recommended, or discussable) regarding adjuvant cytotoxic, endocrine and biologic/targeted therapies, then tested for predictability using stratified ten-fold cross-validations. The predictions so derived were duly compared with those based on published (ESMO and NCCN) cancer guidelines.Results: Machine learning more accurately predicted adjuvant chemotherapy MDT decisions than did simple application of guidelines. No differences were found between MDT- vs. ESMO/NCCN- based decisions to prescribe either adjuvant endocrine (97%, p = 0.44/0.74) or biologic/targeted therapies (98%, p = 0.82/0.59). In contrast, significant discrepancies were evident between MDT- and guideline-based decisions to prescribe chemotherapy (87%, p < 0.01, representing 43% and 53% variations from ESMO/NCCN guidelines, respectively). Using ten-fold cross-validation, the best classifiers achieved areas under the receiver operating characteristic curve (AUC) of 0.940 for chemotherapy (95% C.I., 0.922-0.958), 0.899 for the endocrine therapy (95% C.I., 0.880-0.918), and 0.977 for trastuzumab therapy (95% C.I., 0.955-0.999) respectively. Overall, bootstrap aggregated classifiers performed better among all evaluated machine learning models.Conclusions: A machine learning approach based on clinicopathologic characteristics can predict MDT decisions about adjuvant breast cancer drug therapies. The discrepancy between MDT- and guideline-based decisions regarding adjuvant chemotherapy implies that certain non-clincopathologic criteria, such as patient preference and resource availability, are factored into clinical decision-making by local experts but not captured by guidelines. SN - 1471-2407 AD - Department of Oncology, St Vincent's Hospital, The Kinghorn Cancer Centre, 370 Victoria St, Darlinghurst, Sydney, Australia AD - Garvan Institute of Medical Research, Sydney, Australia AD - The University of New South Wales, Sydney, NSW, Australia AD - The University of Sydney, Sydney, NSW, Australia U2 - PMID: 27905893. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=120348784&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - GEN ID - 120152953 T1 - 70-Gene Signature in Early-Stage Breast Cancer. AU - Blok, Erik J. AU - van de Velde, Cornelis J. AU - Smit, Vincent T. Y1 - 2016/12//12/1/2016 N1 - Accession Number: 120152953. Language: English. Entry Date: 20161225. Revision Date: 20170125. Publication Type: letter; commentary. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 0255562. KW - Breast Neoplasms KW - Gene Expression Profiling KW - Oligonucleotide Array Sequence Analysis KW - Prognosis SP - 2199 EP - 2199 JO - New England Journal of Medicine JF - New England Journal of Medicine JA - N ENGL J MED VL - 375 IS - 22 CY - Waltham, Massachusetts PB - New England Journal of Medicine AB - A letter to the editor is presented in response to the article "70-Gene signature as an aid to treatment decisions in early-stage breast cancer," by F. Cardoso and colleagues in the August 25, 2016 issue. SN - 0028-4793 AD - Leiden University Medical Center Leiden, the Netherlands U2 - PMID: 27959763. DO - 10.1056/NEJMc1612048 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=120152953&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 119582768 T1 - Does physician communication style impact patient report of decision quality for breast cancer treatment? AU - Martinez, Kathryn A. AU - Resnicow, Ken AU - Williams, Geoffrey C. AU - Silva, Marlene AU - Abrahamse, Paul AU - Shumway, Dean A. AU - Wallner, Lauren P. AU - Katz, Steven J. AU - Hawley, Sarah T. Y1 - 2016/12// N1 - Accession Number: 119582768. Language: English. Entry Date: 20170910. Revision Date: 20171209. Publication Type: journal article. Journal Subset: Core Nursing; Europe; Health Promotion/Education; Nursing; Peer Reviewed; UK & Ireland. Instrumentation: Perceived Stress Scale (PSS) (Cohen et al); Clinical Decision Making in Nursing Scale (CDMNS) (Jenkins); Impact of Events Scale (IES); Ferrans and Powers Quality of Life Index. Grant Information: P01 CA163233/CA/NCI NIH HHS/United States. NLM UID: 8406280. KW - Physicians -- Psychosocial Factors KW - Patient Satisfaction KW - Breast Neoplasms -- Psychosocial Factors KW - Decision Making KW - Consumer Participation KW - Communication KW - Middle Age KW - Adult KW - Breast Neoplasms -- Therapy KW - Physician-Patient Relations KW - Female KW - Autonomy KW - Outcome Assessment KW - Ferrans and Powers Quality of Life Index KW - Impact of Events Scale KW - Scales SP - 1947 EP - 1954 JO - Patient Education & Counseling JF - Patient Education & Counseling JA - PATIENT EDUC COUNS VL - 99 IS - 12 PB - Elsevier B.V. AB - Objective: Provider communication that supports patient autonomy has been associated with numerous positive patient outcomes. However, to date, no research has examined the relationship between perceived provider communication style and patient-assessed decision quality in breast cancer.Methods: Using a population-based sample of women with localized breast cancer, we assessed patient perceptions of autonomy-supportive communication from their surgeons and medical oncologists, as well as patient-reported decision quality. We used multivariable linear regression to examine the association between autonomy-supportive communication and subjective decision quality for surgery and chemotherapy decisions, controlling for sociodemographic and clinical factors, as well as patient-reported communication preference (non-directive or directive).Results: Among the 1690 women included in the overall sample, patient-reported decision quality scores were positively associated with higher levels of perceived autonomy-supportive communication from surgeons (β=0.30; p<0.001) and medical oncologists (β=0.26; p<0.001). Patient communication style preference moderated the association between physician communication style received and perceived decision quality.Conclusion: Autonomy-supportive communication by physicians was associated with higher subjective decision quality among women with localized breast cancer. These results support future efforts to design interventions that enhance autonomy-supportive communication.Practice Implications: Autonomy-supportive communication by cancer doctors can improve patients' perceived decision quality. SN - 0738-3991 AD - Cleveland Clinic, Center for Value-Based Care Research, 9500 Euclid Ave, G10 Cleveland, OH 44195, USA AD - University of Michigan School of Public Health, 109 Observatory Street Ann Arbor, MI 48109-2029, USA AD - University of Rochester, School of Medicine, 500 Joseph C. Wilson Blvd Rochester, NY 14611, USA AD - University of Lisbon, Faculty of Human Kinetics, Estrada da Costa, 1495-710, Cruz Quebrada, Lisbon, Portugal AD - University of Michigan School of Medicine, 2800 Plymouth Road, Ann Arbor, MI 48109, USA U2 - PMID: 27395750. DO - 10.1016/j.pec.2016.06.025 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=119582768&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 119975041 T1 - Acceptability and pilot efficacy trial of a web-based breast reconstruction decision support aid for women considering mastectomy. AU - Manne, Sharon L. AU - Topham, Neal AU - D'Agostino, Thomas A. AU - Myers Virtue, Shannon AU - Kirstein, Laurie AU - Brill, Kristin AU - Manning, Cheryl AU - Grana, Generosa AU - Schwartz, Marc D. AU - Ohman-Strickland, Pamela Y1 - 2016/12// N1 - Accession Number: 119975041. Language: English. Entry Date: In Process. Revision Date: 20171221. Publication Type: journal article; research; randomized controlled trial. Journal Subset: Biomedical; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. Special Interest: Evidence-Based Practice. Grant Information: R21 CA149531/CA/NCI NIH HHS/United States. NLM UID: 9214524. KW - Breast Reconstruction -- Psychosocial Factors KW - Breast Neoplasms -- Surgery KW - Breast Neoplasms -- Psychosocial Factors KW - Support, Psychosocial KW - Internet KW - Patient Attitudes KW - Decision Support Techniques KW - Human KW - Pilot Studies KW - Mastectomy -- Psychosocial Factors KW - Treatment Outcomes KW - Middle Age KW - Aged KW - Adult KW - Female KW - Validation Studies KW - Comparative Studies KW - Evaluation Research KW - Multicenter Studies KW - Randomized Controlled Trials SP - 1424 EP - 1433 JO - Psycho-Oncology JF - Psycho-Oncology JA - PSYCHO ONCOL VL - 25 IS - 12 CY - Hoboken, New Jersey PB - John Wiley & Sons, Inc. AB - Objective: The study aim was to test the acceptability and preliminary efficacy of a novel interactive web-based breast reconstruction decision support aid (BRAID) for newly diagnosed breast cancer patients considering mastectomy.Methods: Fifty-five women considering mastectomy were randomly assigned to receive the BRAID versus the Cancer Support Community's Frankly Speaking About Cancer: Breast Reconstruction pamphlet. Participants completed measures of breast reconstruction (BR) knowledge, preparation to make a decision, decisional conflict, anxiety, and BR intentions before randomization and 2 weeks later.Results: In terms of acceptability, enrollment into the study was satisfactory, but the rate of return for follow-up surveys was lower among BRAID participants than pamphlet participants. Both interventions were evaluated favorably in terms of their value in facilitating the BR decision, and the majority of participants completing the follow-up reported viewing the materials. In terms of preliminary efficacy, both interventions resulted in significant increases in BR knowledge and completeness and satisfaction with preparation to make a BR decision, and both interventions resulted in a significant reduction in decision conflict. However, there were no differences between interventions.Conclusion: A widely available free pamphlet and a web-based customized decision aid were highly utilized. The pamphlet was as effective in educating women about BR and prepared women equally as well to make the BR decision as compared with a more costly, customized web-based decision support aid. Copyright © 2015 John Wiley & Sons, Ltd. SN - 1057-9249 AD - Department of Medicine, Robert Wood Johnson Medical School, Section of Population Science, Rutgers Cancer Institute of New Jersey AD - Department of Surgery, Fox Chase Cancer Center AD - MD Anderson Cancer Center at Cooper Health Systems AD - Triad Interactive, Inc AD - Lombardi Cancer Center U2 - PMID: 26383833. DO - 10.1002/pon.3984 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=119975041&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 119732270 T1 - Random Subspace Aggregation for Cancer Prediction with Gene Expression Profiles. AU - Yang, Liying AU - Liu, Zhimin AU - Yuan, Xiguo AU - Wei, Jianhua AU - Zhang, Junying Y1 - 2016/11/24/ N1 - Accession Number: 119732270. Language: English. Entry Date: 20161130. Revision Date: 20161130. Publication Type: Article; algorithm; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Oncologic Care. Grant Information: This work was supported by the Natural Science Foundation of Shaanxi Province (CN) (2015JM6275), the Natural Science Foundation of China (61571341), and the Fundamental Research Funds for the Central Universities (JB160304).. NLM UID: 101600173. KW - Gene Expression Profiling -- Evaluation KW - Neoplasms -- Familial and Genetic KW - Neoplasms -- Diagnosis KW - Neoplasms -- Therapy KW - Gene Expression Profiling -- Methods KW - Descriptive Statistics KW - Artificial Intelligence KW - Neoplasms -- Classification KW - Validity KW - Decision Trees KW - Algorithms KW - Breast Neoplasms -- Familial and Genetic KW - Leukemia -- Familial and Genetic KW - Lung Neoplasms -- Familial and Genetic KW - Prostatic Neoplasms -- Familial and Genetic KW - Colonic Neoplasms -- Familial and Genetic KW - Ovarian Neoplasms -- Familial and Genetic KW - Central Nervous System Neoplasms -- Familial and Genetic KW - T-Tests KW - P-Value KW - Data Analysis Software KW - Factor Analysis KW - Lymphoma, B-Cell -- Familial and Genetic KW - Confidence Intervals KW - Funding Source SP - 1 EP - 10 JO - BioMed Research International JF - BioMed Research International JA - BIOMED RES INT VL - 2016 CY - London, PB - Hindawi Limited AB - Background. Precisely predicting cancer is crucial for cancer treatment. Gene expression profiles make it possible to analyze patterns between genes and cancers on the genome-wide scale. Gene expression data analysis, however, is confronted with enormous challenges for its characteristics, such as high dimensionality, small sample size, and low Signal-to-Noise Ratio. Results. This paper proposes a method, termed RS_SVM, to predict gene expression profiles via aggregating SVM trained on random subspaces. After choosing gene features through statistical analysis, RS_SVM randomly selects feature subsets to yield random subspaces and training SVM classifiers accordingly and then aggregates SVM classifiers to capture the advantage of ensemble learning. Experiments on eight real gene expression datasets are performed to validate the RS_SVM method. Experimental results show that RS_SVM achieved better classification accuracy and generalization performance in contrast with single SVM, K-nearest neighbor, decision tree, Bagging, AdaBoost, and the state-of-the-art methods. Experiments also explored the effect of subspace size on prediction performance. Conclusions. The proposed RS_SVM method yielded superior performance in analyzing gene expression profiles, which demonstrates that RS_SVM provides a good channel for such biological data. SN - 2314-6133 AD - School of Computer Science and Technology, Xidian University, Xi’an, Shaanxi 710071, China AD - State Key Laboratory of Military Stomatology, Department of Maxillofacial Surgery, School of Stomatology, the Fourth Military Medical University, Xi’an, China DO - 10.1155/2016/4596326 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=119732270&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 119759949 T1 - Assessing the acceptability and feasibility of encounter decision aids for early stage breast cancer targeted at underserved patients. AU - Alam, Shama AU - Elwyn, Glyn AU - Percac-Lima, Sanja AU - Grande, Stuart AU - Durand, Marie-Anne Y1 - 2016/11/21/ N1 - Accession Number: 119759949. Language: English. Entry Date: In Process. Revision Date: 20161201. Publication Type: Article. Journal Subset: Biomedical; Computer/Information Science; Europe; UK & Ireland. NLM UID: 101088682. SP - 1 EP - 13 JO - BMC Medical Informatics & Decision Making JF - BMC Medical Informatics & Decision Making JA - BMC MED INFORM DECIS MAKING VL - 16 PB - BioMed Central SN - 1472-6947 AD - Dartmouth Institute for Health Policy and Clinical Practice, Level 5, Williamson Translational Research Building, One Medical Center Drive, Lebanon NH 03756, USA AD - Massachusetts General Hospital, Boston, MA, USA AD - Harvard Medical School, Boston, MA, USA DO - 10.1186/s12911-016-0384-2 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=119759949&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 119807230 T1 - Assessing the acceptability and feasibility of encounter decision aids for early stage breast cancer targeted at underserved patients. AU - Alam, Shama AU - Elwyn, Glyn AU - Percac-Lima, Sanja AU - Grande, Stuart AU - Durand, Marie-Anne Y1 - 2016/11/21/ N1 - Accession Number: 119807230. Language: English. Entry Date: In Process. Revision Date: 20171231. Publication Type: journal article. Journal Subset: Biomedical; Computer/Information Science; Europe; UK & Ireland. Instrumentation: Perceived Stress Scale (PSS) (Cohen et al); Impact of Events Scale (IES); Dyadic Adjustment Scale; Self-Efficacy Scale (SES). NLM UID: 101088682. KW - Social Class KW - Decision Support Techniques KW - Patient Attitudes KW - Breast Neoplasms -- Psychosocial Factors KW - Special Populations -- Psychosocial Factors KW - Aged KW - Middle Age KW - Female KW - Pilot Studies KW - Adult KW - Dyadic Adjustment Scale KW - Impact of Events Scale KW - Scales SP - 147 EP - 147 JO - BMC Medical Informatics & Decision Making JF - BMC Medical Informatics & Decision Making JA - BMC MED INFORM DECIS MAKING VL - 16 PB - BioMed Central AB - Background: Women of low socioeconomic status (SES) diagnosed with early stage breast cancer are less likely to be involved in treatment decisions. They tend to report higher decisional regret and poorer communication. Evidence suggests that well-designed encounter decision aids (DAs) could improve outcomes and potentially reduce healthcare disparities. Our goal was to evaluate the acceptability and feasibility of encounter decision aids (Option Grid, Comic Option Grid, and Picture Option Grid) adapted for a low-SES and low-literacy population.Methods: We used a multi-phase, mixed-methods approach. In phase 1, we conducted a focus group with rural community stakeholders. In phase 2, we developed and administered a web-based questionnaire with patients of low and high SES. In phase 3, we interviewed patients of low SES and relevant healthcare professionals.Results: Data from phase 1 (n = 5) highlighted the importance of addressing treatment costs for patients. Data from phase 2 (n = 268) and phase 3 (n = 15) indicated that using both visual displays and numbers are helpful for understanding statistical information. Data from all three phases suggested that using plain language and simple images (Picture Option Grid) was most acceptable and feasible. The Comic Option Grid was deemed least acceptable.Conclusion: Option Grid and Picture Option Grid appeared acceptable and feasible in facilitating patient involvement and improving perceived understanding among patients of high and low SES. Picture Option Grid was considered most acceptable, accessible and feasible in the clinic visit. However, given the small sample sizes used, those findings need to be interpreted with caution. Further research is needed to determine the impact of pictorial and text-based encounter decision aids in underserved patients and across socioeconomic strata. SN - 1472-6947 AD - The Dartmouth Institute for Health Policy and Clinical Practice, Level 5, Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH 03756, USA AD - Massachusetts General Hospital, Boston, MA, USA AD - Harvard Medical School, Boston, MA, USA U2 - PMID: 27871271. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=119807230&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 119606763 T1 - Attitudes and Decisional Conflict Regarding Breast Reconstruction Among Breast Cancer Patients. AU - Manne, Sharon L. AU - Topham, Neal AU - Kirstein, Laurie AU - Myers Virtue, Shannon AU - Brill, Kristin AU - Devine, Katie A. AU - Gajda, Tina AU - Frederick, Sara AU - Darabos, Katie AU - Sorice, Kristen Y1 - 2016/11//Nov/Dec2016 N1 - Accession Number: 119606763. Language: English. Entry Date: 20161210. Revision Date: 20161216. Publication Type: Article; research; tables/charts. Journal Subset: Core Nursing; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Nursing; Peer Reviewed; USA. Special Interest: Women's Health. Instrumentation: State-Trait Anxiety Inventory (STAI)(Spielberger); Decisional Conflict Scale. Grant Information: This work was supported by an R21 grant (CA149531).. NLM UID: 7805358. KW - Breast Neoplasms -- Surgery -- United States KW - Breast Reconstruction KW - Decision Making, Patient KW - Patient Attitudes KW - Health Knowledge KW - Human KW - Female KW - Regression KW - United States KW - Adult KW - Middle Age KW - Descriptive Statistics KW - Coefficient Alpha KW - Scales KW - State-Trait Anxiety Inventory KW - T-Tests KW - Analysis of Variance KW - P-Value KW - Pilot Studies KW - Mastectomy KW - Lumpectomy KW - Funding Source SP - 427 EP - 436 JO - Cancer Nursing JF - Cancer Nursing JA - CANCER NURS VL - 39 IS - 6 CY - Baltimore, Maryland PB - Lippincott Williams & Wilkins AB - Background: The decision to undergo breast reconstruction (BR) surgery after mastectomy is made during stressful circumstances. Many women do not feel well prepared to make this decision. Objective: Using the Ottawa Decision Support Framework, this study aims to describe women's reasons to choose or not choose BR, BR knowledge, decisional preparedness, and decisional conflict about BR. Possible demographic, medical, BR knowledge, and attitudinal correlates of decisional conflict about BR were also evaluated. Methods: Participants were 55 women with early-stage breast cancer drawn from the baseline data of a pilot randomized trial evaluating the efficacy of a BR decision support aid for breast cancer patients considering BR. Results: The most highly ranked reasons to choose BR were the desire for breasts to be equal in size, the desire to wake up from surgery with a breast in place, and perceived bother of a scar with no breast. The most highly ranked reasons not to choose BR were related to the surgical risks and complications. Regression analyses indicated that decisional conflict was associated with higher number of reasons not to choose BR and lower levels of decisional preparedness. Conclusions: The results suggest that breast cancer patients considering BR may benefit from decisional support. Implications for Clinical Practice: Healthcare professionals may facilitate decision making by focusing on reasons for each patient's uncertainty and unaddressed concerns. All patients, even those who have consulted with a plastic surgeon and remain uncertain about their decision, may benefit from decision support from a health professional. SN - 0162-220X AD - Section of Population Science, Department of Medicine, Robert Wood Johnson Medical School, Rutgers, the Cancer Institute of New Jersey, New Brunswick AD - Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania AD - MD Anderson Cancer Center at Cooper Health Systems, Voorhees Township, New Jersey AD - Department of Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania DO - 10.1097/NCC.0000000000000320 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=119606763&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 118247913 T1 - Qualitative assessment of information and decision support needs for managing menopausal symptoms after breast cancer. AU - Balneaves, Lynda AU - Panagiotoglou, Dimitra AU - Brazier, Alison AU - Lambert, Leah AU - Porcino, Antony AU - Forbes, Margaret AU - Patten, Cheri AU - Truant, Tracy AU - Seely, Dugald AU - Stacey, Dawn AU - Balneaves, Lynda G AU - Brazier, Alison S A AU - Lambert, Leah K AU - Van Patten, Cheri AU - Truant, Tracy L O Y1 - 2016/11// N1 - Accession Number: 118247913. Language: English. Entry Date: In Process. Revision Date: 20171101. Publication Type: journal article. Journal Subset: Biomedical; Continental Europe; Double Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed. Instrumentation: Conflict Tactics Scale (CTS); Ferrans and Powers Quality of Life Index; Impact of Events Scale (IES); Dyadic Adjustment Scale; General Health Questionnaire (GHQ). NLM UID: 9302957. KW - Alternative Therapies -- Methods KW - Menopause -- Physiology KW - Breast Neoplasms -- Complications KW - Middle Age KW - Breast Neoplasms -- Therapy KW - Decision Making KW - Evaluation Research KW - Focus Groups KW - Adult KW - Female KW - Dyadic Adjustment Scale KW - Ferrans and Powers Quality of Life Index KW - Impact of Events Scale KW - Questionnaires KW - Scales SP - 4567 EP - 4575 JO - Supportive Care in Cancer JF - Supportive Care in Cancer JA - SUPPORT CARE CANCER VL - 24 IS - 11 CY - , PB - Springer Science & Business Media B.V. AB - Purpose: For breast cancer (BrCa) survivors, premature menopause can result from conventional cancer treatment. Due to limited treatment options, survivors often turn to complementary therapies (CTs), but struggle to make informed decisions. In this study, we identified BrCa survivors' CT and general information and decision-making needs related to menopausal symptoms.Methods: The needs assessment was informed by interpretive descriptive methodology. Focus groups with survivors (n = 22) and interviews with conventional (n = 12) and CT (n = 5) healthcare professionals (HCPs) were conducted at two Canadian urban cancer centers. Thematic, inductive analysis was conducted on the data.Results: Menopausal symptoms have significant negative impact on BrCa survivors. Close to 70 % of the sample were currently using CTs, including mind-body therapies (45.5 %), natural health products (NHPs) and dietary therapies (31.8 %), and lifestyle interventions (36.4 %). However, BrCa survivors reported inadequate access to information on the safety and efficacy of CT options. Survivors also struggled in their efforts to discuss CT with HCPs, who had limited time and information to support women in their CT decisions. Concise and credible information about CTs was required by BrCa survivors to support them in making informed and safe decisions about using CTs for menopausal symptom management.Conclusions: High quality research is needed on the efficacy and safety of CTs in managing menopausal symptoms following BrCa treatment. Decision support strategies, such as patient decision aids (DAs), may help synthesize and translate evidence on CTs and promote shared decision-making between BrCa survivors and HCPs about the role of CTs in coping with menopause following cancer treatment. SN - 0941-4355 AD - School of Nursing , University of British Columbia , Vancouver Canada AD - Faculty of Medicine and Dentistry , University of Alberta , Edmonton Canada AD - Juravinski Cancer Centre , Hamilton Canada AD - British Columbia Cancer Agency , Vancouver Canada AD - Ottawa Integrative Cancer Centre , Ottawa Canada AD - School of Nursing , University of Ottawa , Ottawa Canada AD - Centre for Integrative Medicine, Leslie Dan Faculty of Pharmacy, 144 College St., Room 737, Toronto, ON, M5S 3M2, Canada AD - Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada AD - School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada AD - British Columbia Cancer Agency, Vancouver, British Columbia, Canada U2 - PMID: 27278271. DO - 10.1007/s00520-016-3296-x UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=118247913&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 119265346 T1 - Reoperation costs in attempted breast-conserving surgery: a decision analysis. AU - Pataky, R. E. AU - Baliski, C. R. Y1 - 2016/10// N1 - Accession Number: 119265346. Language: English. Entry Date: In Process. Revision Date: 20161112. Publication Type: Article. Journal Subset: Biomedical; Canada; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed. NLM UID: 9502503. SP - 314 EP - 321 JO - Current Oncology JF - Current Oncology JA - CURR ONCOL VL - 23 IS - 5 CY - Milton, Ontario PB - Multimed Inc. AB - Background Breast-conserving surgery (BCS) is the preferred surgical approach for most patients with early-stage breast cancer. Frequently, concerns arise about the pathologic margin status, resulting in an average reoperation rate of 23% in Canada. No consensus has been reached about the ideal reoperation rate, although 10% has been suggested as a target. Upon undergoing reoperation, many patients choose mastectomy and breast reconstruction, which add to the morbidity and cost of patient care. We attempted to identify the cost of reoperation after BCS, and the effect that a reduction in the reoperation rate could have on the B.C. health care system. Methods A decision tree was constructed to estimate the average cost per patient undergoing initial BCS with two reoperation frequency scenarios: 23% and 10%. The model included the direct medical costs from the perspective of the B.C. health care system for the most common surgical treatment options, including breast reconstruction and postoperative radiation therapy. Results Costs ranged from a low of $8,225 per patient with definitive BCS [95% confidence interval (CI): $8,061 to $8,383] to a high of $26,026 for reoperation with mastectomy and delayed reconstruction (95% CI: $23,991 to $28,122). If the reoperation rate could be reduced to 10%, the average saving would be $1,055 per patient undergoing attempted BCS (95% CI: $959 to $1,156). If the lower rate were to be achieved in British Columbia, it would translate into a savings of $1.9 million annually. Summary The implementation of initiatives to reduce reoperation after BCS could result in significant savings to the health care system, while potentially improving the quality of patient care. SN - 1198-0052 AD - Canadian Centre for Applied Research in Cancer Control, BC Cancer Agency, Vancouver, BC AD - Surgical Oncology, Sindi Ahluwalia Hawkins Centre for the Southern Interior, BC Cancer Agency, Kelowna, BC AD - Department of Surgery, University of British Columbia, Vancouver, BC DO - 10.3747/co.23.2989 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=119265346&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 120434901 T1 - ONCOLOGISTS' BARRIERS AND FACILITATORS FOR ONCOTYPE DX USE: QUALITATIVE STUDY. AU - Roberts, Megan C. AU - Bryson, Amy AU - Weinberger, Morris AU - Dusetzina, Stacie B. AU - Dinan, Michaela A. AU - Reeder-Hayes, Katherine AU - Wheeler, Stephanie B. Y1 - 2016/10// N1 - Accession Number: 120434901. Language: English. Entry Date: In Process. Revision Date: 20170701. Publication Type: journal article. Journal Subset: Biomedical; Europe; UK & Ireland. Instrumentation: Clinical Decision Making in Nursing Scale (CDMNS) (Jenkins); Perceived Stress Scale (PSS) (Cohen et al); Attitudes to Treatment Questionnaire (ATQ). Grant Information: R00 HS022189/HS/AHRQ HHS/United States. NLM UID: 8508113. KW - Breast Neoplasms -- Drug Therapy KW - Breast Neoplasms KW - Gene Expression Profiling -- Statistics and Numerical Data KW - Chemotherapy, Adjuvant -- Statistics and Numerical Data KW - Attitude to Health KW - Middle Age KW - Female KW - Male KW - Qualitative Studies KW - Interviews KW - Adult KW - Questionnaires KW - Scales SP - 355 EP - 361 JO - International Journal of Technology Assessment in Health Care JF - International Journal of Technology Assessment in Health Care JA - INT J TECHNOL ASSESS HEALTH CARE VL - 32 IS - 5 PB - Cambridge University Press AB - Background: Oncotype DX (ODX), a tumor gene profiling test, has been incorporated into clinical guidelines to aid in adjuvant chemotherapy decision making for early-stage, hormone receptor positive breast cancer patients. Despite United States (U.S.) guidelines, less than half of eligible women receive testing. Reasons for low usage are unclear: Our objective was to better understand U.S. oncologists' ODX uptake and how they use ODX during adjuvant chemotherapy decision making.Methods: We conducted semi-structured, ~30-minute phone interviews with medical and surgical oncologists in one U.S. State using purposive sampling. Oncologists were included if they saw greater than or equal to five breast cancer patients per week. Recruitment ended upon thematic saturation. Interviews were recorded, transcribed, and double-coded using template analysis.Results: During analysis, themes emerged across three domains. First, organizational factors (i.e., departmental structure, ODX marketing, and medical/insurance guidelines) influenced ease of ODX use. Second, oncologists referenced the influence of interpersonal factors (e.g., normative beliefs and peer use of ODX) over their own practices and recommendations. Third, intrapersonal factors (e.g., oncologist attitudes, perceived barriers, and research gaps) were discussed: although oncologists largely held positive attitudes about ODX, they reported challenges with interpreting intermediate scores for treatment decisions and explaining test results to patients. Finally, oncologists identified several research gaps.Conclusions: As more tumor gene profiling tests are incorporated into cancer care for treatment decision making, it is important to understand their use in clinical practice. This study identified multi-level factors that influence ODX uptake into clinical practice, providing insights into facilitators and modifiable barriers that can be leveraged for improving ODX uptake to aid treatment decision making. SN - 0266-4623 AD - Health Policy Management, Gillings School of Global Public Health, UNC AD - Lineberger Comprehensive Cancer Center, UNC AD - Health Behavior, Gillings School of Global Public Health, UNC AD - Center for Health Services Research, Durham Veterans Affairs Medical Center AD - Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy AD - Duke Clinical Research Institute, Duke University AD - Duke Cancer Institute, Duke University AD - Division of Hematology/Oncology, UNC U2 - PMID: 27958190. DO - 10.1017/S026646231600060X UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=120434901&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 118091357 T1 - Inadequate Systems to Support Breast and Cervical Cancer Screening in Primary Care Practice. AU - Schapira, Marilyn AU - Sprague, Brian AU - Klabunde, Carrie AU - Tosteson, Anna AU - Bitton, Asaf AU - Chen, Jane AU - Beaber, Elisabeth AU - Onega, Tracy AU - MacLean, Charles AU - Harris, Kimberly AU - Howe, Kathleen AU - Pearson, Loretta AU - Feldman, Sarah AU - Brawarsky, Phyllis AU - Haas, Jennifer AU - Schapira, Marilyn M AU - Sprague, Brian L AU - Klabunde, Carrie N AU - Tosteson, Anna N A AU - Chen, Jane S Y1 - 2016/10// N1 - Accession Number: 118091357. Corporate Author: PROSPR consortium. Language: English. Entry Date: In Process. Revision Date: 20171222. Publication Type: journal article. Journal Subset: Biomedical; Continental Europe; Europe. Instrumentation: Clinical Decision Making in Nursing Scale (CDMNS) (Jenkins); Home Observation for Measurement of the Environment (HOME) (Bradley and Caldwell); General Health Questionnaire (GHQ); Ferrans and Powers Quality of Life Index. Grant Information: P01 CA154292/CA/NCI NIH HHS/United States. NLM UID: 8605834. KW - Cervix Neoplasms -- Diagnosis KW - Primary Health Care -- Standards KW - Early Detection of Cancer -- Standards KW - Breast Neoplasms -- Diagnosis KW - Middle Age KW - Professional Practice -- Statistics and Numerical Data KW - Health Services Research -- Methods KW - Reminder Systems -- Utilization KW - Male KW - Patient Centered Care -- Standards KW - Adult KW - Early Detection of Cancer -- Methods KW - Guideline Adherence -- Statistics and Numerical Data KW - Primary Health Care -- Administration KW - Patient Centered Care -- Administration KW - Professional Practice -- Standards KW - Surveys KW - Female KW - Practice Guidelines KW - Aged KW - Decision Support Systems, Clinical -- Standards KW - United States KW - Ferrans and Powers Quality of Life Index KW - Questionnaires KW - Scales SP - 1148 EP - 1155 JO - JGIM: Journal of General Internal Medicine JF - JGIM: Journal of General Internal Medicine JA - J GEN INTERN MED VL - 31 IS - 10 CY - , PB - Springer Science & Business Media B.V. AB - Background: Despite substantial resources devoted to cancer screening nationally, the availability of clinical practice-based systems to support screening guidelines is not known.Objective: To characterize the prevalence and correlates of practice-based systems to support breast and cervical cancer screening, with a focus on the patient-centered medical home (PCMH).Design: Web and mail survey of primary care providers conducted in 2014. The survey assessed provider (gender, training) and facility (size, specialty training, physician report of National Committee for Quality Assurance (NCQA) PCMH recognition, and practice affiliation) characteristics. A hierarchical multivariate analysis clustered by clinical practice was conducted to evaluate characteristics associated with the adoption of practice-based systems and technology to support guideline-adherent screening.Participants: Primary care physicians in family medicine, general internal medicine, and obstetrics and gynecology, and nurse practitioners or physician assistants from four clinical care networks affiliated with PROSPR (Population-based Research Optimizing Screening through Personalized Regimens) consortium research centers.Main Measures: The prevalence of routine breast cancer risk assessment, electronic health record (EHR) decision support, comparative performance reports, and panel reports of patients due for routine screening and follow-up.Key Results: There were 385 participants (57.6 % of eligible). Forty-seven percent (47.0 %) of providers reported NCQA recognition as a PCMH. Less than half reported EHR decision support for breast (48.8 %) or cervical cancer (46.2 %) screening. A minority received comparative performance reports for breast (26.2 %) or cervical (19.7 %) cancer screening, automated reports of patients overdue for breast (18.7 %) or cervical (16.4 %) cancer screening, or follow-up of abnormal breast (18.1 %) or cervical (17.6 %) cancer screening tests. In multivariate analysis, reported NCQA recognition as a PCMH was associated with greater use of comparative performance reports of guideline-adherent breast (OR 3.23, 95 % CI 1.58-6.61) or cervical (OR 2.56, 95 % CI 1.32-4.96) cancer screening and automated reports of patients overdue for breast (OR 2.19, 95 % CI 1.15-41.7) or cervical (OR. 2.56, 95 % CI 1.26-5.26) cancer screening.Conclusions: Providers lack systems to support breast and cervical cancer screening. Practice transformation toward a PCMH may support the adoption of systems to achieve guideline-adherent cancer screening in primary care settings. SN - 0884-8734 AD - University of Pennsylvania and the Philadelphia VA Medical Center , 1110 Blockley Hall, 423 Guardian Drive Philadelphia 19104 USA AD - University of Vermont , Burlington USA AD - Office of Disease Prevention, Office of the Director , National Institutes of Health , Bethesda USA AD - Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center , Lebanon USA AD - Brigham and Women's Hospital , Boston USA AD - Fred Hutchinson Cancer Research Center , Seattle USA AD - Division of General Internal Medicine and Primary Care , Brigham and Woman's Hospital , Boston USA AD - University of Pennsylvania and the Philadelphia VA Medical Center, 1110 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA AD - University of Vermont, Burlington, VT, USA AD - Office of Disease Prevention, Office of the Director, National Institutes of Health, Bethesda, MD, USA AD - Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH, USA AD - Brigham and Women's Hospital, Boston, MA, USA U2 - PMID: 27251058. DO - 10.1007/s11606-016-3726-y UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=118091357&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 118681007 T1 - Multidisciplinary Management of Breast Cancer Brain Metastases. AU - Zagar, Timothy M. AU - Van Swearingen, Amanda E. D. AU - Kaidar-Person, Orit AU - Ewend, Matthew G. AU - Anders, Carey K. Y1 - 2016/10// N1 - Accession Number: 118681007. Language: English. Entry Date: 20161208. Revision Date: 20161208. Publication Type: Article; algorithm; review; tables/charts. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Evidence-Based Practice; Women's Health. NLM UID: 8712059. KW - Breast Neoplasms -- Complications KW - Neoplasm Metastasis KW - Brain Neoplasms -- Diagnosis KW - Brain Neoplasms -- Therapy KW - Multidisciplinary Care Team KW - Professional Practice, Evidence-Based KW - Oncologic Care KW - Oncology KW - Cancer Care Facilities KW - Cancer Patients KW - Breast Neoplasms -- Classification KW - Breast Neoplasms -- Physiopathology KW - Breast Neoplasms -- Prognosis KW - Brain Neoplasms -- Epidemiology KW - Brain Neoplasms -- Physiopathology KW - Brain Neoplasms -- Symptoms KW - Brain Neoplasms -- Drug Therapy KW - Brain Neoplasms -- Surgery KW - Brain Neoplasms -- Mortality KW - Brain Neoplasms -- Prognosis KW - Brain Neoplasms -- Radiotherapy KW - Brain Neoplasms -- Complications KW - Neuroradiography KW - Magnetic Resonance Imaging KW - Neurosurgery KW - Radiosurgery KW - Decision Making, Clinical KW - Decision Trees KW - Radiation Dosage KW - Radiotherapy, Adjuvant KW - Survival Analysis KW - Clinical Trials KW - Treatment Outcomes KW - Cognition KW - Radiation Injuries KW - Brain -- Radiation Effects KW - Antibodies, Monoclonal -- Therapeutic Use KW - Antineoplastic Agents -- Therapeutic Use KW - Drugs, Investigational KW - Chemotherapy, Cancer SP - 923 EP - 933 JO - Oncology (08909091) JF - Oncology (08909091) JA - ONCOLOGY (08909091) VL - 30 IS - 10 CY - Norwalk, Connecticut PB - UBM Medica SN - 0890-9091 AD - Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina AD - Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina AD - Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina AD - Department of Medicine, Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=118681007&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 118152520 T1 - Effects of a risk-based online mammography intervention on accuracy of perceived risk and mammography intentions. AU - Seitz, Holli H. AU - Gibson, Laura AU - Skubisz, Christine AU - Forquer, Heather AU - Mello, Susan AU - Schapira, Marilyn M. AU - Armstrong, Katrina AU - Cappella, Joseph N. Y1 - 2016/10// N1 - Accession Number: 118152520. Language: English. Entry Date: 20170910. Revision Date: 20171003. Publication Type: journal article; research; randomized controlled trial. Journal Subset: Core Nursing; Europe; Health Promotion/Education; Nursing; Peer Reviewed; UK & Ireland. Special Interest: Evidence-Based Practice. Instrumentation: Perceived Stress Scale (PSS) (Cohen et al); Clinical Decision Making in Nursing Scale (CDMNS) (Jenkins); Screen for Caregiver Burden (SCB); Behavior Rating Inventory of Executive Function (BRIEF). Grant Information: U54 CA163313/CA/NCI NIH HHS/United States. NLM UID: 8406280. KW - Intention KW - Women -- Psychosocial Factors KW - Patient Attitudes KW - Decision Support Techniques KW - Health Education -- Methods KW - Breast Neoplasms -- Prevention and Control KW - Mammography KW - Decision Making KW - Breast Neoplasms -- Psychosocial Factors KW - Probability KW - Aged KW - Breast Neoplasms KW - Adult KW - Female KW - Attitude to Health KW - Models, Theoretical KW - Human KW - Middle Age KW - Internet KW - Pennsylvania KW - Early Detection of Cancer KW - Validation Studies KW - Comparative Studies KW - Evaluation Research KW - Multicenter Studies KW - Randomized Controlled Trials KW - Clinical Assessment Tools KW - Scales SP - 1647 EP - 1656 JO - Patient Education & Counseling JF - Patient Education & Counseling JA - PATIENT EDUC COUNS VL - 99 IS - 10 PB - Elsevier B.V. AB - Objective: This experiment tested the effects of an individualized risk-based online mammography decision intervention. The intervention employs exemplification theory and the Elaboration Likelihood Model of persuasion to improve the match between breast cancer risk and mammography intentions.Methods: 2918 women ages 35-49 were stratified into two levels of 10-year breast cancer risk (<1.5%; ≥1.5%) then randomly assigned to one of eight conditions: two comparison conditions and six risk-based intervention conditions that varied according to a 2 (amount of content: brief vs. extended) x 3 (format: expository vs. untailored exemplar [example case] vs. tailored exemplar) design. Outcomes included mammography intentions and accuracy of perceived breast cancer risk.Results: Risk-based intervention conditions improved the match between objective risk estimates and perceived risk, especially for high-numeracy women with a 10-year breast cancer risk ≤1.5%. For women with a risk≤1.5%, exemplars improved accuracy of perceived risk and all risk-based interventions increased intentions to wait until age 50 to screen.Conclusion: A risk-based mammography intervention improved accuracy of perceived risk and the match between objective risk estimates and mammography intentions.Practice Implications: Interventions could be applied in online or clinical settings to help women understand risk and make mammography decisions. SN - 0738-3991 AD - Annenberg School for Communication, University of Pennsylvania, 3620 Walnut Street, Philadelphia, PA, 19104, USA AD - Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA AD - Center for Health Equity Research and Promotion, Crescenz VA Medical Center, Philadelphia, PA 19104, USA U2 - PMID: 27178707. DO - 10.1016/j.pec.2016.05.005 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=118152520&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 118272500 T1 - Outcomes of contralateral prophylactic mastectomy in relation to familial history: a decision analysis (BRCR-D-16-00033). AU - Davies, Kalatu R. AU - Brewster, Abenaa M. AU - Bedrosian, Isabelle AU - Parker, Patricia A. AU - Crosby, Melissa A. AU - Peterson, Susan K. AU - Yu Shen AU - Volk, Robert J. AU - Cantor, Scott B. AU - Shen, Yu Y1 - 2016/09/20/ N1 - Accession Number: 118272500. Language: English. Entry Date: In Process. Revision Date: 20170817. Publication Type: journal article. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. Instrumentation: Profile of Mood States (POMS); Clinical Decision Making in Nursing Scale (CDMNS) (Jenkins); Longitudinal Interval Follow-Up Evaluation (LIFE); Ferrans and Powers Quality of Life Index. Grant Information: P30 CA008748/CA/NCI NIH HHS/United States. NLM UID: 100927353. KW - Breast Neoplasms -- Surgery KW - Breast Neoplasms -- Mortality KW - Neoplasm Staging KW - Breast Neoplasms -- Pathology KW - Body Weights and Measures KW - Life Expectancy KW - Risk Factors KW - Female KW - Aged KW - Population Surveillance KW - Quality of Life KW - Outcome Assessment KW - Probability KW - Adult KW - Middle Age KW - Ferrans and Powers Quality of Life Index KW - Scales SP - 93 EP - 93 JO - Breast Cancer Research JF - Breast Cancer Research JA - BREAST CANCER RES VL - 18 PB - BioMed Central AB - Background: Family history of breast cancer is associated with an increased risk of contralateral breast cancer (CBC) even in the absence of mutations in the breast cancer susceptibility genes BRCA1/2. We compared quality-adjusted survival after contralateral prophylactic mastectomy (CPM) with surveillance only (no CPM) among women with breast cancer incorporating the degree of family history.Methods: We created a microsimulation model for women with first-degree, second-degree, and no family history treated for a stage I, II, or III estrogen receptor (ER)-positive or ER-negative breast cancer at the ages of 40, 50, 60, and 70. The model incorporated a 10-year posttreatment period for risk of developing CBC and/or dying of the primary cancer or CBC. For each patient profile, we used 100,000 microsimulation trials to estimate quality-adjusted life expectancy for the clinical strategies CPM and no CPM.Results: CPM showed minimal improvement on quality-adjusted life expectancy among women age 50-60 with no or a unilateral first-degree or second-degree family history (decreasing from 0.31 to -0.06 quality-adjusted life-years (QALYs)) and was unfavorable for most subgroups of women age 70 with stage III breast cancer regardless of degree of family history (range -0.08 to -0.02 QALYs). Sensitivity analysis showed that the highest predicted benefit of CPM assuming 95 % risk reduction in CBC was 0.57 QALYs for a 40-year-old woman with stage I breast cancer who had a first-degree relative with bilateral breast cancer.Conclusions: Women age 40 with stage I breast cancer and a first-degree relative with bilateral breast cancer have a QALY benefit from CPM similar to that reported for BRCA1/2 mutation carriers. For most subgroups of women, CPM has a minimal to no effect on quality-adjusted life expectancy, irrespective of family history of breast cancer. SN - 1465-5411 AD - Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Unit 1444, P.O. Box 301402, Houston, TX 77230-1402, USA AD - Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX, USA AD - Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA AD - Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA AD - Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA AD - Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA AD - Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA U2 - PMID: 27650678. DO - 10.1186/s13058-016-0752-y UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=118272500&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 118160615 T1 - 3 QUESTIONS ON...Whether Online Support Guides Better Treatment Decisions. AU - DIGIULIO, SARAH Y1 - 2016/09/10/ N1 - Accession Number: 118160615. Language: English. Entry Date: 20161103. Revision Date: 20161103. Publication Type: Article; questions and answers. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 8100849. KW - Social Media -- Utilization KW - Decision Making, Patient KW - Cancer Patients KW - Internet -- Utilization KW - Communication -- Methods KW - Breast Neoplasms SP - 42 EP - 42 JO - Oncology Times JF - Oncology Times JA - ONCOL TIMES VL - 38 IS - 17 CY - Baltimore, Maryland PB - Lippincott Williams & Wilkins SN - 0276-2234 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=118160615&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 116380967 T1 - Transitioning to routine breast cancer risk assessment and management in primary care: what can we learn from cardiovascular disease? AU - Phillips, Kelly-Anne AU - Steel, Emma J. AU - Collins, Ian AU - Emery, Jon AU - Pirotta, Marie AU - Mann, G. Bruce AU - Butow, Phyllis AU - Hopper, John L. AU - Trainer, Alison AU - Moreton, Jane AU - Antoniou, Antonis C. AU - Cuzick, Jack AU - Keogh, Louise Y1 - 2016/09// N1 - Accession Number: 116380967. Language: English. Entry Date: 20160628. Revision Date: 20160630. Publication Type: Article; research; tables/charts. Journal Subset: Australia & New Zealand; Double Blind Peer Reviewed; Expert Peer Reviewed; Peer Reviewed; Public Health. Special Interest: Oncologic Care; Women's Health. NLM UID: 101123037. KW - Breast Neoplasms -- Prevention and Control KW - Risk Assessment KW - Breast Neoplasms -- Risk Factors KW - Primary Health Care KW - Human KW - Focus Groups KW - Nurses KW - Physicians, Family KW - Cancer Screening KW - Australia KW - Male KW - Female KW - Adult KW - Middle Age KW - Health Personnel KW - Data Analysis Software KW - Audiorecording KW - Thematic Analysis KW - Clinical Assessment Tools KW - Cardiovascular Diseases -- Prevention and Control KW - Professional Role SP - 255 EP - 261 JO - Australian Journal of Primary Health JF - Australian Journal of Primary Health JA - AUST J PRIM HEALTH VL - 22 IS - 3 CY - Clayton, VIC, PB - CSIRO Publishing AB - To capitalise on advances in breast cancer prevention, all women would need to have their breast cancer risk formally assessed. With ~85% of Australians attending primary care clinics at least once a year, primary care is an opportune location for formal breast cancer risk assessment and management. This study assessed the current practice and needs of primary care clinicians regarding assessment and management of breast cancer risk. Two facilitated focus group discussions were held with 17 primary care clinicians (12 GPs and 5 practice nurses (PNs)) as part of a larger needs assessment. Primary care clinicians viewed assessment and management of cardiovascular risk as an intrinsic, expected part of their role, often triggered by practice software prompts and facilitated by use of an online tool. Conversely, assessment of breast cancer risk was not routine and was generally patient- (not clinician-) initiated, and risk management (apart from routine screening) was considered outside the primary care domain. Clinicians suggested that routine assessment and management of breast cancer risk might be achieved if it were widely endorsed as within the remit of primary care and supported by an online risk-assessment and decision aid tool that was integrated into primary care software. This study identified several key issues that would need to be addressed to facilitate the transition to routine assessment and management of breast cancer risk in primary care, based largely on the model used for cardiovascular disease. SN - 1448-7527 AD - Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, East Melbourne, Vic. 8006, Australia AD - Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3010, Australia AD - Department of Medicine, St Vincent's Hospital, 29 Regent Street, Fitzroy, Vic. 3065, Australia AD - General Practice and Primary Care Academic Centre, University of Melbourne, 200 Berkeley Street, Carlton, Vic. 3053, Australia AD - Breast Service, Royal Melbourne and Royal Women's Hospital, 20 Flemington Road, Parkville, Vic. 3052, Australia AD - Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), University of Sydney, Transient Building F12, Darlington, NSW 2006, Australia AD - School of Public Health, Seoul National University, 1 Gwanek-ro, Gwanek-gu, Seoul 151-742, Korea AD - Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Worts Causeway, Cambridge, CB1 8RN, United Kingdom AD - Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, United Kingdom AD - Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3010, Australia DO - 10.1071/PY14156 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=116380967&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - ID - 119266892 T1 - Decision Support for a Woman Considering Continuing Extended Endocrine Therapy for Breast Cancer: A Case Study. AU - Liska, Carrie M. AU - Stacey, Dawn Y1 - 2016///Fall2016 N1 - Accession Number: 119266892. Language: English. Entry Date: In Process. Revision Date: 20170109. Publication Type: Case Study. Journal Subset: Canada; Core Nursing; Nursing; Peer Reviewed. NLM UID: 9300792. SP - 297 EP - 311 JO - Canadian Oncology Nursing Journal JF - Canadian Oncology Nursing Journal JA - CAN ONCOL NURS J VL - 26 IS - 4 CY - Pembroke, Ontario PB - Pappin Communications AB - This case study evaluated decision coaching with a breast cancer survivor considering continuing extended endocrine therapy from eight years to 10 years. The survivor, aged 58 years and who completed surgery and chemotherapy eight years ago, was concerned about side effects of endocrine therapy. Decision coaching based on the Ottawa Decision Support Framework involved an oncology nurse using the Ottawa Personal Decision Guide. Compared to baseline (2 out of 4), decisional comfort improved (3 out of 4) post decision coaching. The survivor felt more certain, but wanted further advice from her oncologist. She was leaning toward discontinuing endocrine therapy given she valued quality of life over a small risk of recurrence. Audio-recording analysis using the Decision Support Analysis Tool revealed high decision coaching quality (10/10). Breast cancer survivors facing preference-sensitive decisions about extended endocrine therapy could be supported with decision coaching by oncology nurses to ensure informed values-based decisions. AB - Dans cette étude de cas, on a évalué l'accompagnement en soins décisionnels offert à une survivante du cancer du sein qui, après huit ans d'endocrinothérapie, s'est interrogée sur la prolongation du traitement sur dix ans. La survivante de 58 ans qui a subi une intervention chirurgicale et une chimiothérapie il y a huit ans s'inquiétait des effets secondaires de l'endocrinothérapie. Cet accompagnement inspiré du Modèle d'aide à la décision d'Ottawa (https://decisionaid.ohri.ca/francais/mado.html) a fait intervenir une infirmière en oncologie qui a utilisé le Guide personnel d'aide à la décision d'Ottawa. Si l'on en juge par le résultat de référence (2 sur 4), le réconfort apporté au moment de la prise de décision a amélioré l'accompagnement post-décisionnel (3 sur 4). La survivante se sentait plus sûre de sa décision, mais désirait un nouvel avis de son oncologue. Elle songeait à mettre fin à l'endocrinothérapie du fait qu'elle accordait plus d'importance à sa qualité de vie qu'au léger risque de récurrence du cancer. L'analyse de l'enregistrement audio avec l'outil d'analyse de l'aide à la décision a révélé la grande qualité de l'accompagnement (10/10). Les survivantes du cancer du sein qui s'interrogent sur la prolongation de l'endocrinothérapie pourraient profiter de l'accompagnement d'infirmières en oncologie pour prendre des décisions éclairées axées sur leurs valeurs. SN - 1181-912X AD - Care Facilitator, The Wellness Beyond Cancer Program, The Ottawa Hospital, Ottawa, Canada AD - Faculty of Health Sciences, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Canada DO - 10.5737/23688076264297303 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=119266892&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 118144820 T1 - Comparing Breast Cancer Multiparameter Tests in the OPTIMA Prelim Trial: No Test Is More Equal Than the Others. AU - Bartlett, John M. S. AU - Bayani, Jane AU - Marshall, Andrea AU - Dunn, Janet A. AU - Campbell, Amy AU - Cunningham, Carrie AU - Sobol, Monika S. AU - Hall, Peter S. AU - Poole, Christopher J. AU - Cameron, David A. AU - Earl, Helena M. AU - Rea, Daniel W. AU - Macpherson, Iain R. AU - Canney, Peter AU - Francis, Adele AU - McCabe, Christopher AU - Pinder, Sarah E. AU - Hughes-Davies, Luke AU - Makris, Andreas AU - Stein, Robert C. Y1 - 2016/09// N1 - Accession Number: 118144820. Corporate Author: OPTIMA TMG. Language: English. Entry Date: In Process. Revision Date: 20171115. Publication Type: journal article; research; randomized controlled trial. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Evidence-Based Practice. Grant Information: RP-PG-0707-10101//Department of Health/United Kingdom. NLM UID: 7503089. KW - Breast Neoplasms -- Drug Therapy KW - Neoplasm Recurrence, Local -- Drug Therapy KW - Breast Neoplasms -- Classification KW - Decision Support Techniques KW - Female KW - Body Weights and Measures KW - Middle Age KW - Neoplasm Metastasis KW - Models, Statistical KW - Antineoplastic Agents, Hormonal -- Therapeutic Use KW - Receptors, Cell Surface -- Analysis KW - Predictive Value of Tests KW - Adult KW - Proteins -- Analysis KW - Aged KW - Confidence Intervals KW - Risk Assessment -- Methods KW - Human KW - Breast Neoplasms -- Pathology KW - Prognosis KW - Breast Neoplasms KW - Antineoplastic Agents, Combined -- Therapeutic Use KW - Validation Studies KW - Comparative Studies KW - Evaluation Research KW - Multicenter Studies KW - Randomized Controlled Trials SP - 1 EP - 9 JO - JNCI: Journal of the National Cancer Institute JF - JNCI: Journal of the National Cancer Institute JA - J NATL CANCER INST VL - 108 IS - 9 PB - Oxford University Press / USA AB - Background: Previous reports identifying discordance between multiparameter tests at the individual patient level have been largely attributed to methodological shortcomings of multiple in silico studies. Comparisons between tests, when performed using actual diagnostic assays, have been predicted to demonstrate high degrees of concordance. OPTIMA prelim compared predicted risk stratification and subtype classification of different multiparameter tests performed directly on the same population.Methods: Three hundred thirteen women with early breast cancer were randomized to standard (chemotherapy and endocrine therapy) or test-directed (chemotherapy if Oncotype DX recurrence score >25) treatment. Risk stratification was also determined with Prosigna (PAM50), MammaPrint, MammaTyper, NexCourse Breast (IHC4-AQUA), and conventional IHC4 (IHC4). Subtype classification was provided by Blueprint, MammaTyper, and Prosigna.Results: Oncotype DX predicted a higher proportion of tumors as low risk (82.1%, 95% confidence interval [CI] = 77.8% to 86.4%) than were predicted low/intermediate risk using Prosigna (65.5%, 95% CI = 60.1% to 70.9%), IHC4 (72.0%, 95% CI = 66.5% to 77.5%), MammaPrint (61.4%, 95% CI = 55.9% to 66.9%), or NexCourse Breast (61.6%, 95% CI = 55.8% to 67.4%). Strikingly, the five tests showed only modest agreement when dichotomizing results between high vs low/intermediate risk. Only 119 (39.4%) tumors were classified uniformly as either low/intermediate risk or high risk, and 183 (60.6%) were assigned to different risk categories by different tests, although 94 (31.1%) showed agreement between four of five tests. All three subtype tests assigned 59.5% to 62.4% of tumors to luminal A subtype, but only 121 (40.1%) were classified as luminal A by all three tests and only 58 (19.2%) were uniformly assigned as nonluminal A. Discordant subtyping was observed in 123 (40.7%) tumors.Conclusions: Existing evidence on the comparative prognostic information provided by different tests suggests that current multiparameter tests provide broadly equivalent risk information for the population of women with estrogen receptor (ER)-positive breast cancers. However, for the individual patient, tests may provide differing risk categorization and subtype information. SN - 0027-8874 AD - Ontario Institute for Cancer Research, Toronto, Ontario, Canada. AD - University of Toronto, Toronto, Canada. AD - University of Edinburgh, Edinburgh, UK. AD - Warwick Clinical Trials Unit, University of Warwick, Coventry, UK. AD - University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK. AD - University of Cambridge Department of Oncology and NIHR Cambridge Biomedical Research Centre, Cambridge, UK. AD - Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, UK. AD - University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, UK. AD - University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. AD - University of Alberta, Edmonton, AB, Canada. AD - Kings College London, Guy’s Hospital, London, UK. AD - Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. AD - Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Middlesex, UK. AD - National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, UK. U2 - PMID: 27130929. DO - 10.1093/jnci/djw050 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=118144820&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 118144694 T1 - Evaluating Markers for Guiding Treatment. AU - Baker, Stuart G. AU - Bonetti, Marco Y1 - 2016/09// N1 - Accession Number: 118144694. Language: English. Entry Date: In Process. Revision Date: 20170901. Publication Type: journal article. Journal Subset: Biomedical; Peer Reviewed; USA. Instrumentation: Clinical Decision Making in Nursing Scale (CDMNS) (Jenkins); Impact of Events Scale (IES). NLM UID: 7503089. KW - Decision Support Techniques KW - Breast Neoplasms -- Pathology KW - Breast Neoplasms -- Drug Therapy KW - Receptors, Cell Surface -- Analysis KW - Logistic Regression KW - Body Mass Index KW - Age Factors KW - Body Weights and Measures KW - Tamoxifen -- Therapeutic Use KW - Antineoplastic Agents, Hormonal -- Therapeutic Use KW - Organic Chemicals -- Therapeutic Use KW - Female KW - Breast Neoplasms KW - Heterocyclic Compounds -- Therapeutic Use KW - Prognosis KW - Clinical Trials KW - Proteins -- Analysis KW - Tumor Markers, Biological -- Analysis KW - Predictive Value of Tests KW - Neoplasm Metastasis KW - Impact of Events Scale KW - Scales SP - 1 EP - 6 JO - JNCI: Journal of the National Cancer Institute JF - JNCI: Journal of the National Cancer Institute JA - J NATL CANCER INST VL - 108 IS - 9 PB - Oxford University Press / USA AB - Background: The subpopulation treatment effect pattern plot (STEPP) is an appealing method for assessing the clinical impact of a predictive marker on patient outcomes and identifying a promising subgroup for further study. However, its original formulation lacked a decision analytic justification and applied only to a single marker.Methods: We derive a decision-analytic result that motivates STEPP. We discuss the incorporation of multiple predictive markers into STEPP using risk difference, cadit, and responders-only benefit functions.Results: Applying STEPP to data from a breast cancer treatment trial with multiple markers, we found that none of the three benefit functions identified a promising subgroup for further study. Applying STEPP to hypothetical data from a trial with 100 markers, we found that all three benefit functions identified promising subgroups as evidenced by the large statistically significant treatment effect in these subgroups.Conclusions: Because the method has desirable decision-analytic properties and yields an informative plot, it is worth applying to randomized trials on the chance there is a large treatment effect in a subgroup determined by the predictive markers. SN - 0027-8874 AD - Division of Cancer Prevention, National Cancer Institute, Bethesda. AD - Carlo F. Dondena Centre for Research on Social Dynamics and Public Policies and Bocconi University, Milan, Italy. U2 - PMID: 27193772. DO - 10.1093/jnci/djw101 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=118144694&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 117355264 T1 - Unremarked or Unperformed? Systematic Review on Reporting of Validation Efforts of Health Economic Decision Models in Seasonal Influenza and Early Breast Cancer. AU - Boer, Pieter AU - Frederix, Geert AU - Feenstra, Talitha AU - Vemer, Pepijn AU - de Boer, Pieter T AU - Frederix, Geert W J AU - Feenstra, Talitha L Y1 - 2016/09// N1 - Accession Number: 117355264. Language: English. Entry Date: In Process. Revision Date: 20171104. Publication Type: journal article; research. Journal Subset: Australia & New Zealand; Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed. Special Interest: Evidence-Based Practice. Instrumentation: Wechsler Objective Reading Dimensions (WORD); Global Appraisal of Individual Needs (GAIN). NLM UID: 9212404. KW - Decision Support Techniques KW - Breast Neoplasms -- Economics KW - Models, Statistical KW - Influenza, Human -- Economics KW - Study Design KW - Female KW - Decision Making KW - Human KW - Validation Studies KW - Clinical Assessment Tools SP - 833 EP - 845 JO - PharmacoEconomics JF - PharmacoEconomics JA - PHARMACOECONOMICS VL - 34 IS - 9 PB - Springer Science & Business Media B.V. AB - Background: Transparent reporting of validation efforts of health economic models give stakeholders better insight into the credibility of model outcomes. In this study we reviewed recently published studies on seasonal influenza and early breast cancer in order to gain insight into the reporting of model validation efforts in the overall health economic literature.Methods: A literature search was performed in Pubmed and Embase to retrieve health economic modelling studies published between 2008 and 2014. Reporting on model validation was evaluated by checking for the word validation, and by using AdViSHE (Assessment of the Validation Status of Health Economic decision models), a tool containing a structured list of relevant items for validation. Additionally, we contacted corresponding authors to ask whether more validation efforts were performed other than those reported in the manuscripts.Results: A total of 53 studies on seasonal influenza and 41 studies on early breast cancer were included in our review. The word validation was used in 16 studies (30 %) on seasonal influenza and 23 studies (56 %) on early breast cancer; however, in a minority of studies, this referred to a model validation technique. Fifty-seven percent of seasonal influenza studies and 71 % of early breast cancer studies reported one or more validation techniques. Cross-validation of study outcomes was found most often. A limited number of studies reported on model validation efforts, although good examples were identified. Author comments indicated that more validation techniques were performed than those reported in the manuscripts.Conclusions: Although validation is deemed important by many researchers, this is not reflected in the reporting habits of health economic modelling studies. Systematic reporting of validation efforts would be desirable to further enhance decision makers' confidence in health economic models and their outcomes. SN - 1170-7690 AD - Department of Pharmacy, PharmacoTherapy, -Epidemiology and -Economics (PTEE) , University of Groningen , Groningen The Netherlands AD - Pharmacoepidemiology and Clinical Pharmacology , University of Utrecht , Utrecht The Netherlands AD - Department of Pharmacy, PharmacoTherapy, -Epidemiology and -Economics (PTEE), University of Groningen, Groningen, The Netherlands AD - Pharmacoepidemiology and Clinical Pharmacology, University of Utrecht, Utrecht, The Netherlands AD - Department of Epidemiology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands AD - Centre for Nutrition, Prevention and Health Services Research, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands U2 - PMID: 27129572. DO - 10.1007/s40273-016-0410-3 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=117355264&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 117440974 T1 - Automated Breast Ultrasound: Dual-Sided Compared with Single-Sided Imaging. AU - Larson, Eric D. AU - Lee, Won-Mean AU - Roubidoux, Marilyn A. AU - Goodsitt, Mitchel M. AU - Lashbrook, Chris AU - Zafar, Fouzaan AU - Kripfgans, Oliver D. AU - Thomenius, Kai AU - Carson, Paul L. Y1 - 2016/09// N1 - Accession Number: 117440974. Language: English. Entry Date: 20171129. Revision Date: 20171222. Publication Type: journal article; research. Journal Subset: Biomedical; Continental Europe; Europe. Instrumentation: Clinical Decision Making in Nursing Scale (CDMNS) (Jenkins); Ferrans and Powers Quality of Life Index. Grant Information: R01 CA115267/CA/NCI NIH HHS/United States. NLM UID: 0410553. KW - Ultrasonography -- Methods KW - Breast Neoplasms KW - Image Processing, Computer Assisted -- Methods KW - Imaging, Three-Dimensional -- Methods KW - Human KW - Sensitivity and Specificity KW - Reproducibility of Results KW - Female KW - Breast KW - Validation Studies KW - Comparative Studies KW - Evaluation Research KW - Multicenter Studies KW - Ferrans and Powers Quality of Life Index KW - Scales SP - 2072 EP - 2082 JO - Ultrasound in Medicine & Biology JF - Ultrasound in Medicine & Biology JA - ULTRASOUND MED BIOL VL - 42 IS - 9 CY - New York, New York PB - Elsevier B.V. AB - The design and performance of a mammographically configured, dual-sided, automated breast ultrasound (ABUS) 3-D imaging system are described. Dual-sided imaging (superior and inferior) is compared with single-sided imaging to aid decisions on clinical implementation of the more complex, but potentially higher-quality dual-sided imaging. Marked improvement in image quality and coverage of the breast is obtained in dual-sided ultrasound over single-sided ultrasound. Among hypo-echoic masses imaged, there are increases in the mean contrast-to-noise ratio of 57% and 79%, respectively, for spliced dual-sided versus superior or inferior single-sided imaging. The fractional breast volume coverage, defined as the percentage volume in the transducer field of view that is imaged with clinically acceptable quality, is improved from 59% in both superior and inferior single-sided imaging to 89% in dual-sided imaging. Applying acoustic coupling to the breast requires more effort or sophisticated methods in dual-sided imaging than in single-sided imaging. SN - 0301-5629 AD - Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA AD - GE Global Research, Niskayuna, New York, USA U2 - PMID: 27264914. DO - 10.1016/j.ultrasmedbio.2016.05.001 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=117440974&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 117670487 T1 - 70-Gene Signature as an Aid to Treatment Decisions in Early-Stage Breast Cancer. AU - Cardoso, F. AU - van't Veer, L. J. AU - Bogaerts, J. AU - Slaets, L. AU - Viale, G. AU - Delaloge, S. AU - Pierga, J.-Y. AU - Brain, E. AU - Causeret, S. AU - DeLorenzi, M. AU - Glas, A. M. AU - Golfinopoulos, V. AU - Goulioti, T. AU - Knox, S. AU - Matos, E. AU - Meulemans, B. AU - Neijenhuis, P. A. AU - Nitz, U. AU - Passaiacqua, R. AU - Ravdin, P. Y1 - 2016/08/25/ N1 - Accession Number: 117670487. Corporate Author: MINDACT Investigators. Language: English. Entry Date: 20160828. Revision Date: 20170929. Publication Type: journal article; clinical trial; research; randomized controlled trial. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Evidence-Based Practice. Instrumentation: Profile of Mood States (POMS); Clinical Decision Making in Nursing Scale (CDMNS) (Jenkins). Grant Information: //Cancer Research UK/United Kingdom. NLM UID: 0255562. KW - Antineoplastic Agents -- Therapeutic Use KW - Gene Expression Profiling KW - Chemotherapy, Adjuvant KW - Breast Neoplasms KW - Neoplasm Metastasis -- Prevention and Control KW - Disease Susceptibility KW - Breast Neoplasms -- Mortality KW - Adult KW - Genetic Screening KW - Aged KW - Neoplasm Staging KW - Breast Neoplasms -- Drug Therapy KW - Middle Age KW - Female KW - Oligonucleotide Array Sequence Analysis KW - Prospective Studies KW - Human KW - Relative Risk KW - Gene Expression KW - Risk Assessment KW - Prognosis KW - Kaplan-Meier Estimator KW - Mastectomy KW - Breast Neoplasms -- Surgery KW - Clinical Trials KW - Validation Studies KW - Comparative Studies KW - Evaluation Research KW - Multicenter Studies KW - Randomized Controlled Trials KW - Scales SP - 717 EP - 729 JO - New England Journal of Medicine JF - New England Journal of Medicine JA - N ENGL J MED VL - 375 IS - 8 CY - Waltham, Massachusetts PB - New England Journal of Medicine AB - Background: The 70-gene signature test (MammaPrint) has been shown to improve prediction of clinical outcome in women with early-stage breast cancer. We sought to provide prospective evidence of the clinical utility of the addition of the 70-gene signature to standard clinical-pathological criteria in selecting patients for adjuvant chemotherapy.Methods: In this randomized, phase 3 study, we enrolled 6693 women with early-stage breast cancer and determined their genomic risk (using the 70-gene signature) and their clinical risk (using a modified version of Adjuvant! Online). Women at low clinical and genomic risk did not receive chemotherapy, whereas those at high clinical and genomic risk did receive such therapy. In patients with discordant risk results, either the genomic risk or the clinical risk was used to determine the use of chemotherapy. The primary goal was to assess whether, among patients with high-risk clinical features and a low-risk gene-expression profile who did not receive chemotherapy, the lower boundary of the 95% confidence interval for the rate of 5-year survival without distant metastasis would be 92% (i.e., the noninferiority boundary) or higher.Results: A total of 1550 patients (23.2%) were deemed to be at high clinical risk and low genomic risk. At 5 years, the rate of survival without distant metastasis in this group was 94.7% (95% confidence interval, 92.5 to 96.2) among those not receiving chemotherapy. The absolute difference in this survival rate between these patients and those who received chemotherapy was 1.5 percentage points, with the rate being lower without chemotherapy. Similar rates of survival without distant metastasis were reported in the subgroup of patients who had estrogen-receptor-positive, human epidermal growth factor receptor 2-negative, and either node-negative or node-positive disease.Conclusions: Among women with early-stage breast cancer who were at high clinical risk and low genomic risk for recurrence, the receipt of no chemotherapy on the basis of the 70-gene signature led to a 5-year rate of survival without distant metastasis that was 1.5 percentage points lower than the rate with chemotherapy. Given these findings, approximately 46% of women with breast cancer who are at high clinical risk might not require chemotherapy. (Funded by the European Commission Sixth Framework Program and others; ClinicalTrials.gov number, NCT00433589; EudraCT number, 2005-002625-31.). SN - 0028-4793 AD - Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal AD - Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco AD - European Organization for Research and Treatment of Cancer Headquarters AD - University of Milan and Istituto Europeo di Oncologia, Milan AD - Gustave Roussy, Villejuif AD - Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris AD - Institut Curie–Hôpital Rene Huguenin, Saint-Cloud AD - Centre Georges-Francois-Leclerc, Dijon, France AD - Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland AD - Agendia AD - Breast International Group Headquarters, Brussels AD - Europa Donna–European Breast Cancer Coalition, Milan, Italy AD - Institute of Oncology, Ljubljana, Slovenia AD - Alrijne Ziekenhuis, Rijnland Leiderdorp AD - Evangelisches Krankenhaus Bethesda, Duisburg, Germany AD - Azienda Istituti Ospitalieri di Cremona, Cremona, Italy AD - University of Texas Health Sciences Center, San Antonio U2 - PMID: 27557300. DO - 10.1056/NEJMoa1602253 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=117670487&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 116795041 T1 - Osteopontin splice variants are differential predictors of breast cancer treatment responses. AU - Zduniak, Krzysztof AU - Agrawal, Anil AU - Agrawal, Siddarth AU - Hossain, Md Monir AU - Ziolkowski, Piotr AU - Weber, Georg F. Y1 - 2016/07/11/ N1 - Accession Number: 116795041. Language: English. Entry Date: In Process. Revision Date: 20171128. Publication Type: journal article; research. Journal Subset: Biomedical; Europe; UK & Ireland. Instrumentation: Short Portable Mental Status Questionnaire (SPMSQ) (Pfeiffer); Work Environment Scale (WES) (Moos et al). NLM UID: 100967800. KW - Breast Neoplasms -- Drug Therapy KW - Proteins -- Metabolism KW - Antineoplastic Agents, Combined -- Pharmacodynamics KW - Antineoplastic Agents -- Pharmacodynamics KW - Drug Resistance, Neoplasm KW - Tamoxifen -- Therapeutic Use KW - Fluorouracil -- Pharmacodynamics KW - Cyclophosphamide -- Pharmacodynamics KW - Methotrexate -- Pharmacodynamics KW - Breast Neoplasms -- Pathology KW - Cyclophosphamide -- Therapeutic Use KW - Methotrexate -- Therapeutic Use KW - Antineoplastic Agents -- Therapeutic Use KW - Middle Age KW - RNA KW - Immunohistochemistry KW - Proteins KW - Retrospective Design KW - Antineoplastic Agents, Combined -- Therapeutic Use KW - Cox Proportional Hazards Model KW - Breast Neoplasms -- Mortality KW - Fluorouracil -- Therapeutic Use KW - Poland KW - Biopsy KW - Prognosis KW - Female KW - Biological Markers -- Metabolism KW - Scales KW - Short Portable Mental Status Questionnaire SP - 1 EP - 12 JO - BMC Cancer JF - BMC Cancer JA - BMC CANCER VL - 16 PB - BioMed Central AB - Background: Osteopontin is a marker for breast cancer progression, which in previous studies has also been associated with resistance to certain anti-cancer therapies. It is not known which splice variants may mediate treatment resistance.Methods: Here we analyze the association of osteopontin variant expression before treatment, differentiated according to immunohistochemistry with antibodies to exon 4 and to the osteopontin-c splice junction respectively, with the ensuing therapy responses in 119 Polish breast cancer patients who presented between 1995 and 2008.Results: We found from Cox hazard models, logrank test and Wilcoxon test that osteopontin exon 4 was associated with a favorable response to tamoxifen, but a poor response to chemotherapy with CMF (cyclophosphamide, methotrexate, fluorouracil). Osteopontin-c is prognostic, but falls short of being a significant predictor for sensitivity to treatment.Conclusions: The addition of osteopontin splice variant immunohistochemistry to standard pathology work-ups has the potential to aid decision making in breast cancer treatment. SN - 1471-2407 AD - Department of Pathology, Wroclaw Medical University, Wroclaw, Poland AD - Department of General and Oncological Surgery, Wroclaw Medical University, Wroclaw, Poland AD - Division of Biostatistics and Epidemilogy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA AD - University of Cincinnati Academic Health Center, College of Pharmacy, 3225 Eden Avenue, Cincinnati, OH 45267-0004, USA U2 - PMID: 27400751. DO - 10.1186/s12885-016-2484-x UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=116795041&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 115243838 T1 - The phosphorylation-specific association of STMN1 with GRP78 promotes breast cancer metastasis. AU - Kuang, Xia-Ying AU - Jiang, He-Sheng AU - Li, Kai AU - Zheng, Yi-Zi AU - Liu, Yi-Rong AU - Qiao, Feng AU - Li, Shan AU - Hu, Xin AU - Shao, Zhi-Ming Y1 - 2016/07/10/ N1 - Accession Number: 115243838. Language: English. Entry Date: In Process. Revision Date: 20171102. Publication Type: journal article; research. Journal Subset: Biomedical; Europe; UK & Ireland. NLM UID: 7600053. KW - Heat-Shock Proteins -- Metabolism KW - Breast Neoplasms -- Metabolism KW - Lung Neoplasms -- Metabolism KW - Cell Movement KW - Nerve Tissue Proteins -- Metabolism KW - Cell Line, Tumor KW - Serine KW - Time Factors KW - Breast Neoplasms KW - Genetic Techniques KW - Neoplasm Invasiveness KW - Kaplan-Meier Estimator KW - Lung Neoplasms KW - Risk Factors KW - Mice KW - Animals KW - Prognosis KW - Risk Assessment KW - Transferases -- Metabolism KW - Breast Neoplasms -- Mortality KW - Heat-Shock Proteins KW - Nerve Tissue Proteins KW - Genes KW - Decision Support Techniques KW - Female KW - Cox Proportional Hazards Model KW - Phosphorylation KW - Neoplasm Staging KW - Lung Neoplasms -- Mortality KW - Signal Transduction KW - Breast Neoplasms -- Pathology SP - 87 EP - 96 JO - Cancer Letters JF - Cancer Letters JA - CANCER LETT VL - 377 IS - 1 PB - Elsevier B.V. AB - Metastasis is a major cause of death in patients with breast cancer. Stathmin1 (STMN1) is a phosphoprotein associated with cancer metastasis. It exhibits a complicated phosphorylation pattern in response to various extracellular signals, but its signaling mechanism is poorly understood. In this study, we report that phosphorylation of STMN1 at Ser25 and Ser38 is necessary to maintain cell migration capabilities and is associated with shorter disease-free survival (DFS) in breast cancer. In addition, we report that glucose-regulated protein of molecular mass 78 (GRP78) is a novel phospho-STMN1 binding protein upon STMN1 Ser25/Ser38 phosphorylation. This phosphorylation-dependent interaction is regulated by MEK kinase and is required for STMN1-GRP78 complex stability and STMN1-mediated migration. We also propose a prognostic model based on phospho-STMN1 and GRP78 to assess metastatic risk in breast cancer patients. SN - 0304-3835 AD - Key Laboratory of Breast Cancer in Shanghai, Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China AD - Department of Breast Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China AD - Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China AD - Institutes of Biomedical Science, Fudan University, Shanghai, China U2 - PMID: 27130664. DO - 10.1016/j.canlet.2016.04.035 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=115243838&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 115741193 T1 - The influence of gene expression profiling on decisional conflict in decision making for early-stage breast cancer chemotherapy. AU - MacDonald, Karen V. AU - Bombard, Yvonne AU - Deal, Ken AU - Trudeau, Maureen AU - Leighl, Natasha AU - Marshall, Deborah A. Y1 - 2016/07// N1 - Accession Number: 115741193. Language: English. Entry Date: 20160607. Revision Date: 20160607. Publication Type: Article; research. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care; Women's Health. Instrumentation: Decisional Conflict Scale. NLM UID: 9005373. KW - Breast Neoplasms -- Drug Therapy KW - Gene Expression Profiling KW - Chemotherapy, Cancer KW - Decision Making, Patient KW - Conflict (Psychology) KW - Cancer Patients KW - Scales KW - Vignettes KW - Descriptive Statistics KW - Summated Rating Scaling KW - P-Value KW - Paired T-Tests KW - Uncertainty KW - Treatment Refusal KW - Confidence KW - Gene Expression KW - Surveys KW - Experimental Studies KW - Female KW - Human SP - 85 EP - 93 JO - European Journal of Cancer JF - European Journal of Cancer JA - EUR J CANCER VL - 61 PB - Pergamon Press - An Imprint of Elsevier Science AB - Background Women with early-stage breast cancer, of whom only 15% will experience a recurrence, are often conflicted or uncertain about taking chemotherapy. Gene expression profiling (GEP) of tumours informs risk prediction, potentially affecting treatment decisions. We examined whether receiving a GEP test score reduces decisional conflict in chemotherapy treatment decision making. Methods A general population sample of 200 women completed the decisional conflict scale (DCS) at baseline (no GEP test score scenario) and after (scenario with GEP test score added) completing a discrete choice experiment survey for early-stage breast cancer chemotherapy. We scaled the 16-item DCS total scores and subscores from 0 to 100 and calculated means, standard deviations and change in scores, with significance (p < 0.05) based on matched pairs t-tests. Results We identified five respondent subgroups based on preferred treatment option; almost 40% did not change their chemotherapy decision after receiving GEP testing information. Total score and all subscores (uncertainty, informed, values clarity, support, and effective decision) decreased significantly in the respondent subgroup who were unsure about taking chemotherapy initially but changed to no chemotherapy (n =33). In the subgroup of respondents (n = 25) who chose chemotherapy initially but changed to unsure, effective decision subscore increased significantly. In the overall sample, changes in total and all subscores were non-significant. Conclusions GEP testing adds value for women initially unsure about chemotherapy treatment with a decrease in decisional conflict. However, for women who are confident about their treatment decisions, GEP testing may not add value. Decisions to request GEP testing should be personalised based on patient preferences. SN - 0959-8049 AD - Department of Community Health Sciences, University of Calgary, Room 3C62, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada AD - Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Room 312, Toronto, Ontario M5B 1T8, Canada AD - Institute of Health Policy, Management and Evaluation, University of Toronto, 209 Victoria Street, Room 312, Toronto, Ontario M5B 1T8, Canada AD - DeGroote School of Business, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4M4, Canada AD - University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada AD - Department of Medicine, University of Toronto, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada AD - Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada AD - Department of Community Health Sciences, University of Calgary, McMaster University, Room 3C56, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada DO - 10.1016/j.ejca.2016.03.077 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=115741193&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 115925380 T1 - Distance Metric Based Oversampling Method for Bioinformatics and Performance Evaluation. AU - Tsai, Meng-Fong AU - Yu, Shyr-Shen Y1 - 2016/07// N1 - Accession Number: 115925380. Language: English. Entry Date: 20171018. Revision Date: 20171018. Publication Type: Article; equations & formulas; research; tables/charts. Journal Subset: Computer/Information Science; Continental Europe; Europe; Peer Reviewed. NLM UID: 7806056. KW - Bioinformatics KW - Algorithms KW - Decision Support Techniques KW - Human KW - Descriptive Statistics KW - Survival Analysis KW - Breast Neoplasms -- Prognosis KW - Female SP - 1 EP - 9 JO - Journal of Medical Systems JF - Journal of Medical Systems JA - J MED SYST VL - 40 IS - 7 CY - , PB - Springer Science & Business Media B.V. AB - An imbalanced classification means that a dataset has an unequal class distribution among its population. For any given dataset, regardless of any balancing issue, the predictions made by most classification methods are highly accurate for the majority class but significantly less accurate for the minority class. To overcome this problem, this study took several imbalanced datasets from the famed UCI datasets and designed and implemented an efficient algorithm which couples Top-N Reverse k-Nearest Neighbor (TR kNN) with the Synthetic Minority Oversampling TEchnique (SMOTE). The proposed algorithm was investigated by applying it to classification methods such as logistic regression (LR), C4.5, Support Vector Machine (SVM), and Back Propagation Neural Network (BPNN). This research also adopted different distance metrics to classify the same UCI datasets. The empirical results illustrate that the Euclidean and Manhattan distances are not only more accurate, but also show greater computational efficiency when compared to the Chebyshev and Cosine distances. Therefore, the proposed algorithm based on TR kNN and SMOTE can be widely used to handle imbalanced datasets. Our recommendations on choosing suitable distance metrics can also serve as a reference for future studies. SN - 0148-5598 AD - Department of Computer Science and Engineering, National Chung Hsing University, Taichung 402 Taiwan DO - 10.1007/s10916-016-0516-3 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=115925380&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 116159157 T1 - Evaluation of risk communication in a mammography patient decision aid. AU - Klein, Krystal A. AU - Watson, Lindsey AU - Ash, Joan S. AU - Eden, Karen B. Y1 - 2016/07// N1 - Accession Number: 116159157. Language: English. Entry Date: 20170703. Revision Date: 20170817. Publication Type: journal article; research. Journal Subset: Core Nursing; Europe; Health Promotion/Education; Nursing; Peer Reviewed; UK & Ireland. Instrumentation: Ways of Coping Questionnaire (WCQ) (Folkman et al); Perceived Stress Scale (PSS) (Cohen et al). Grant Information: T15 LM007088/LM/NLM NIH HHS/United States. NLM UID: 8406280. KW - Readability KW - Relative Risk KW - Breast Neoplasms -- Diagnosis KW - Mammography -- Psychosocial Factors KW - Communication KW - Decision Support Techniques KW - Female KW - Patient Centered Care KW - Qualitative Studies KW - Decision Making KW - Breast Neoplasms -- Psychosocial Factors KW - Human KW - Interviews KW - Attitude to Health KW - Women's Health KW - Breast Neoplasms -- Prevention and Control KW - Predictive Value of Tests KW - Middle Age KW - Adult KW - Validation Studies KW - Comparative Studies KW - Evaluation Research KW - Multicenter Studies KW - Scales KW - Ways of Coping Questionnaire SP - 1240 EP - 1248 JO - Patient Education & Counseling JF - Patient Education & Counseling JA - PATIENT EDUC COUNS VL - 99 IS - 7 PB - Elsevier B.V. AB - Objectives: We characterized patients' comprehension, memory, and impressions of risk communication messages in a patient decision aid (PtDA), Mammopad, and clarified perceived importance of numeric risk information in medical decision making.Methods: Participants were 75 women in their forties with average risk factors for breast cancer. We used mixed methods, comprising a risk estimation problem administered within a pretest-posttest design, and semi-structured qualitative interviews with a subsample of 21 women.Results: Participants' positive predictive value estimates of screening mammography improved after using Mammopad. Although risk information was only briefly memorable, through content analysis, we identified themes describing why participants value quantitative risk information, and obstacles to understanding. We describe ways the most complicated graphic was incompletely comprehended.Conclusions: Comprehension of risk information following Mammopad use could be improved. Patients valued receiving numeric statistical information, particularly in pictograph format. Obstacles to understanding risk information, including potential for confusion between statistics, should be identified and mitigated in PtDA design.Practice Implications: Using simple pictographs accompanied by text, PtDAs may enhance a shared decision-making discussion. PtDA designers and providers should be aware of benefits and limitations of graphical risk presentations. Incorporating comprehension checks could help identify and correct misapprehensions of graphically presented statistics. SN - 0738-3991 AD - Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, USA U2 - PMID: 26965020. DO - 10.1016/j.pec.2016.02.013 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=116159157&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 117355241 T1 - Trastuzumab Emtansine for Treating HER2-Positive, Unresectable, Locally Advanced or Metastatic Breast Cancer After Treatment with Trastuzumab and a Taxane: An Evidence Review Group Perspective of a NICE Single Technology Appraisal. AU - Squires, Hazel AU - Stevenson, Matt AU - Simpson, Emma AU - Harvey, Rebecca AU - Stevens, John Y1 - 2016/07// N1 - Accession Number: 117355241. Language: English. Entry Date: In Process. Revision Date: 20171117. Publication Type: journal article; research. Journal Subset: Australia & New Zealand; Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed. Special Interest: Evidence-Based Practice. Instrumentation: Propensity for Abusiveness Scale (PAS); Appraisal of Self-Care Agency Scale; Piper Fatigue Scale (PFS); Clinical Decision Making in Nursing Scale (CDMNS) (Jenkins); Impact of Events Scale (IES). NLM UID: 9212404. KW - Breast Neoplasms -- Drug Therapy KW - Antibodies, Monoclonal -- Administration and Dosage KW - Antineoplastic Agents, Combined -- Therapeutic Use KW - Decision Support Techniques KW - Clinical Trials KW - Breast Neoplasms -- Economics KW - Prognosis KW - Breast Neoplasms -- Pathology KW - Survival KW - Antibodies, Monoclonal -- Economics KW - Human KW - Cost Benefit Analysis KW - Heterocyclic Compounds -- Administration and Dosage KW - Neoplasm Metastasis KW - Antineoplastic Agents, Combined -- Economics KW - Receptors, Cell Surface -- Metabolism KW - Female KW - Quality-Adjusted Life Years KW - Hydrocarbons -- Administration and Dosage KW - Meta Analysis KW - Impact of Events Scale KW - Scales SP - 673 EP - 680 JO - PharmacoEconomics JF - PharmacoEconomics JA - PHARMACOECONOMICS VL - 34 IS - 7 PB - Springer Science & Business Media B.V. AB - The National Institute for Health and Care Excellence (NICE) invited the manufacturer of trastuzumab emtansine (T-DM1) (Kadcyla(®); Roche) to submit evidence of its clinical and cost-effectiveness for treating human epidermal growth factor receptor 2 (HER2)-positive, unresectable, locally advanced or metastatic breast cancer after treatment with trastuzumab and a taxane. The School of Health and Related Research Technology Appraisal Group (ScHARR-TAG) at the University of Sheffield were the independent Evidence Review Group (ERG) who produced a critical review of the company's submission to NICE. The ERG also independently searched for relevant evidence and modified the submitted decision analytic model to produce a revised estimate of cost-effectiveness and examine the impact of altering some of the key assumptions. The clinical effectiveness data were taken from two randomised controlled trials that reported a significant advantage in progression-free survival (PFS) for T-DM1 over lapatinib in combination with capecitabine (EMILIA trial), and over the treatment of physician's choice (TH3RESA trial). A network meta-analysis suggested T-DM1 was the best treatment in terms of both overall survival and PFS compared with lapatinib in combination with capecitabine; trastuzumab in combination with capecitabine; and capecitabine monotherapy. Adverse event (AE) data were taken from a pooled analysis of additional trials of T-DM1 as a single agent. The most common grade 3 or greater AEs for T-DM1 were thrombocytopenia and hepatotoxicity. Following the clarification process, the manufacturer reported a deterministic incremental cost-effectiveness ratio (ICER) for T-DM1 compared with lapatinib in combination with capecitabine of £167,236, the latter of which was estimated to have an ICER of £49,798 compared with capecitabine monotherapy. The ERG produced similar values of £166,429 and £50,620 respectively. All other comparators were dominated. During the appraisal, the manufacturer offered an analysis of a patient access scheme (PAS), which suggested that T-DM1 had a 0 % probability of being cost-effective at an ICER of £30,000 per QALY gained. The NICE Appraisal Committee concluded that while the clinical effectiveness of T-DM1 had been proven, it was not likely to represent a cost-effective use of National Health Service resources and therefore its use could not be recommended. SN - 1170-7690 AD - University of Sheffield , Regent Court, 30 Regent Street Sheffield S1 4DA UK U2 - PMID: 26892972. DO - 10.1007/s40273-016-0386-z UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=117355241&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 113219861 T1 - Celebrity Health Announcements and Online Health Information Seeking: An Analysis of Angelina Jolie’s Preventative Health Decision. AU - Dean, Marleah Y1 - 2016/06// N1 - Accession Number: 113219861. Language: English. Entry Date: 20160226. Revision Date: 20171123. Publication Type: Article; research. Journal Subset: Blind Peer Reviewed; Health Promotion/Education; Peer Reviewed; USA. Special Interest: Oncologic Care; Women's Health. NLM UID: 8908762. KW - Health Information KW - Information Seeking Behavior KW - Internet KW - Public Figures KW - Decision Making, Patient KW - Breast Neoplasms -- Familial and Genetic KW - Breast Neoplasms -- Prevention and Control KW - Mastectomy KW - Qualitative Studies KW - Content Analysis KW - Human KW - Genetics, Medical KW - Gender Identity KW - Genes, BRCA KW - Constant Comparative Method KW - Thematic Analysis KW - Health Services Accessibility KW - Insurance, Health KW - Health Care Costs KW - Search Engines KW - Female KW - Gender Role SP - 752 EP - 761 JO - Health Communication JF - Health Communication JA - HEALTH COMMUN VL - 31 IS - 6 CY - Philadelphia, Pennsylvania PB - Taylor & Francis Ltd AB - On May 14, 2013, Angelina Jolie disclosed she carries BRCA1, which means she has an 87% risk of developing breast cancer during her lifetime. Jolie decided to undergo a preventative bilateral mastectomy (PBM), reducing her risk to 5%. The purpose of this study was to analyze the type of information individuals are exposed to when using the Internet to search health information regarding Jolie’s decision. Qualitative content analysis revealed four main themes—information about genetics, information about a PBM, information about health care, and information about Jolie’s gender identity. Broadly, the identified websites mention Jolie’s high risk for developing cancer due to the genetic mutation BRCA1, describe a PBM occasionally noting reasons why she had this surgery and providing alternatives to the surgery, discuss issues related to health care services, costs, and insurances about Jolie’s health decision, and portray Jolie as a sexual icon, a partner to Brad Pitt, a mother of six children, and an inspirational humanitarian. The websites also depict Jolie’s health decision in positive, negative, and/or both ways. Discussion centers on how this actress’ health decision impacts the public. SN - 1041-0236 AD - Department of Communication, University of South Florida DO - 10.1080/10410236.2014.995866 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=113219861&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 115449195 T1 - Affective forecasting and medication decision making in breast-cancer prevention. AU - Hoerger, Michael AU - Scherer, Laura D. AU - Fagerlin, Angela Y1 - 2016/06// N1 - Accession Number: 115449195. Language: English. Entry Date: 20160523. Revision Date: 20160523. Publication Type: Article; research. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 8211523. KW - Breast Neoplasms KW - Chemoprevention KW - Tamoxifen -- Administration and Dosage KW - Raloxifene -- Administration and Dosage KW - Decision Making, Patient KW - Human KW - Stress, Psychological KW - Odds Ratio KW - Female KW - United States KW - Forecasting SP - 594 EP - 603 JO - Health Psychology JF - Health Psychology JA - HEALTH PSYCHOL VL - 35 IS - 6 CY - Washington, District of Columbia PB - American Psychological Association AB - Objective: Over 2 million American women at elevated risk for breast cancer are eligible to take chemoprevention medications such as tamoxifen and raloxifene, which can cut in half the risk of developing breast cancer, but which also have a number of side effects. Historically, very few at-risk women have opted to use chemoprevention medications. Affective forecasting theory suggests that people may avoid these medications if they expect taking them to increase their health-related stress. Method: After receiving an individually tailored decision aid that provided personalized information about the risks and benefits of these medications, 661 women at elevated risk of breast cancer were asked to make 3 affective forecasts, predicting what their level of health-related stress would be if they took tamoxifen, raloxifene, or neither medication. They also completed measures of decisional preferences and intentions, and at a 3-month follow-up, reported on whether or not they had decided to use either medication. Results: On the affective forecasting items, very few women (<10%) expected the medications to reduce their health-related stress, relative to no medication at all. Participants with more negative affective forecasts about taking a chemoprevention medication expressed lower preferences and intentions for using the medications (Cohen's ds from 0.74 to 0.79) and were more likely to have opted against using medication at follow-up (OR range = 1.34-2.66). Conclusion: These findings suggest that affective forecasting may explain avoidance of breast-cancer chemoprevention medications. They also highlight the need for more research aimed at integrating emotional content into decision aids. SN - 0278-6133 DO - 10.1037/hea0000324 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=115449195&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 116948240 T1 - Pathways Clinical Decision Support for Appropriate Use of Key Biomarkers. AU - Ellis, Peter G. AU - Brufsky, Adam M. AU - Beriwal, Sushil AU - Lokay, Kathleen G. AU - Benson, Hans O. AU - McCutcheon, Stephanie B. AU - Krebs, Melinda Y1 - 2016/06// N1 - Accession Number: 116948240. Language: English. Entry Date: 20160728. Revision Date: 20160728. Publication Type: Article; critical path; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; USA. NLM UID: 101261852. KW - Breast Neoplasms -- Therapy KW - Decision Making, Clinical -- Methods KW - Decision Support Systems, Clinical -- Utilization KW - Molecular Diagnostic Techniques -- Utilization KW - Biological Markers -- Diagnostic Use KW - Oncogenes -- Classification KW - Chemotherapy, Adjuvant -- Utilization KW - Human KW - Female KW - Retrospective Design KW - Descriptive Statistics KW - Middle Age KW - Young Adult KW - Adult KW - Aged KW - Aged, 80 and Over KW - Neoplasm Recurrence, Local KW - Algorithms SP - 568 EP - e686 JO - Journal of Oncology Practice JF - Journal of Oncology Practice JA - J ONCOL PRACT VL - 12 IS - 6 CY - Alexandria, Virginia PB - American Society of Clinical Oncology AB - Purpose Breast cancer diagnostics have the ability to predict disease recurrence and the benefit of chemotherapy. This study measures the use of a diagnostic assay, Oncotype DX, when embedded in a breast cancer decision support algorithm and, on the basis of the assay results, the use of chemotherapy in the adjuvant setting. Methods UPMC CancerCenter retrospectively reviewed patients with estrogen receptor-positive, human epidermal growth factor receptor 2 (HER2)Neu-negative disease with zero to three positive nodes navigated in the Via Pathways decision support portal during a 12-month period. The breast algorithm prompted input of the assay recurrence score (RS) and then recommended hormonal therapy alone (HT) for low RS, or chemotherapy followed by HT for high RS. The patient's RS was correlated with the treatment decision. Results During this time period, 643 patients had ER-positive, HER2Neu-negative disease with zero to three positive nodes. Of those, 596 (92.7%) had diagnostic testing to determine chemotherapy plus HT versus HT alone, and 47 had chemotherapy followed by HT without an RS. For node-negative patients classified with low or high RS, pathway treatment adherence rates were 99.7% and 96.6%, respectively; node-positive patients had 95.7% and 87.5% adherence rates, respectively. Conclusion This analysis demonstrates the use of a clinical pathway to measure the adoption of a diagnostic test, the Oncotype DX breast assay, and the use of the appropriate therapy on the basis of the RS. As more diagnostics are established to aid in the personalized treatment of diseases, pathways may be important in maintaining clinician awareness of the appropriate disease presentations where these tests should be used, measuring usage of these tests, and tracking the treatment decisions on the basis of test results. SN - 1554-7477 AD - UPMC CancerCenter AD - University of Pittsburgh Cancer Center DO - 10.1200/JOP.2015.010546 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=116948240&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 116247646 T1 - Decisions on Further Research for Predictive Biomarkers of High-Dose Alkylating Chemotherapy in Triple-Negative Breast Cancer: A Value of Information Analysis. AU - Miquel-Cases, Anna AU - Retèl, Valesca P. AU - van Harten, Wim H. AU - Steuten, Lotte M.G. Y1 - 2016/06// N1 - Accession Number: 116247646. Language: English. Entry Date: 20170601. Revision Date: 20170601. Publication Type: journal article. Journal Subset: Biomedical; Peer Reviewed; USA. Instrumentation: Profile of Mood States (POMS); Clinical Decision Making in Nursing Scale (CDMNS) (Jenkins). NLM UID: 100883818. KW - Breast Neoplasms -- Economics KW - Enzymes -- Economics KW - Probability KW - Breast Neoplasms -- Drug Therapy KW - Human KW - Prognosis KW - Health and Welfare Planning -- Economics KW - Enzymes KW - Cost Benefit Analysis KW - Clinical Trials KW - Female KW - Middle Age KW - Research -- Economics KW - Alkylating Agents -- Economics KW - Adult KW - Breast Neoplasms -- Epidemiology KW - RNA KW - Antineoplastic Agents -- Therapeutic Use KW - Netherlands KW - Breast Neoplasms -- Therapy KW - Decision Support Techniques KW - Antineoplastic Agents -- Economics KW - Alkylating Agents -- Therapeutic Use KW - Validation Studies KW - Comparative Studies KW - Evaluation Research KW - Multicenter Studies KW - Scales SP - 419 EP - 430 JO - Value in Health JF - Value in Health JA - VALUE HEALTH VL - 19 IS - 4 CY - New York, New York PB - Elsevier B.V. AB - Objectives: To inform decisions about the design and priority of further studies of emerging predictive biomarkers of high-dose alkylating chemotherapy (HDAC) in triple-negative breast cancer (TNBC) using value-of-information analysis.Methods: A state transition model compared treating women with TNBC with current clinical practice and four biomarker strategies to personalize HDAC: 1) BRCA1-like profile by array comparative genomic hybridization (aCGH) testing; 2) BRCA1-like profile by multiplex ligation-dependent probe amplification (MLPA) testing; 3) strategy 1 followed by X-inactive specific transcript gene (XIST) and tumor suppressor p53 binding protein (53BP1) testing; and 4) strategy 2 followed by XIST and 53BP1 testing, from a Dutch societal perspective and a 20-year time horizon. Input data came from literature and expert opinions. We assessed the expected value of partial perfect information, the expected value of sample information, and the expected net benefit of sampling for potential ancillary studies of an ongoing randomized controlled trial (RCT; NCT01057069).Results: The expected value of partial perfect information indicated that further research should be prioritized to the parameter group including "biomarkers' prevalence, positive predictive value (PPV), and treatment response rates (TRRs) in biomarker-negative patients and patients with TNBC" (€639 million), followed by utilities (€48 million), costs (€40 million), and transition probabilities (TPs) (€30 million). By setting up four ancillary studies to the ongoing RCT, data on 1) TP and MLPA prevalence, PPV, and TRR; 2) aCGH and aCGH/MLPA plus XIST and 53BP1 prevalence, PPV, and TRR; 3) utilities; and 4) costs could be simultaneously collected (optimal size = 3000).Conclusions: Further research on predictive biomarkers for HDAC should focus on gathering data on TPs, prevalence, PPV, TRRs, utilities, and costs from the four ancillary studies to the ongoing RCT. SN - 1098-3015 AD - Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AVL), Amsterdam, The Netherlands AD - Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands AD - Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA U2 - PMID: 27325334. DO - 10.1016/j.jval.2016.01.015 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=116247646&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 114820679 T1 - Comparative Risk: Good or Bad Heuristic? AU - Schwartz, Peter H. Y1 - 2016/05// N1 - Accession Number: 114820679. Language: English. Entry Date: 20160429. Revision Date: 20171023. Publication Type: Article. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 100898738. KW - Decision Making, Clinical -- Evaluation KW - Environment KW - Bioethics KW - Cultural Bias KW - Thinking KW - Access to Information -- Methods KW - Patient Care KW - Probability KW - Tamoxifen -- Therapeutic Use KW - Breast Neoplasms -- Risk Factors KW - Patient Education -- Methods KW - Female KW - Emotions SP - 20 EP - 22 JO - American Journal of Bioethics JF - American Journal of Bioethics JA - AM J BIOETHICS VL - 16 IS - 5 CY - Oxfordshire, PB - Routledge AB - The author argues that doctors and decision aids should provide comparative risk information to patients to improve quality or rationality of decisions and to avoid bias. He addresses the controversy of providing comparative risk information when the goal of communication is to support informed decision-making, and disagrees with the disclosure of comparative risk information to women considering tamoxifen for breast cancer prevention. SN - 1526-5161 AD - Indiana University DO - 10.1080/15265161.2016.1159765 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=114820679&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 114495808 T1 - Establishing Cost-Effective Allocation of Proton Therapy for Breast Irradiation. AU - Mailhot Vega, Raymond B. AU - Ishaq, Omar AU - Raldow, Ann AU - Perez, Carmen A. AU - Jimenez, Rachel AU - Scherrer-Crosbie, Marielle AU - Bussiere, Marc AU - Taghian, Alphonse AU - Sher, David J. AU - MacDonald, Shannon M. Y1 - 2016/05// N1 - Accession Number: 114495808. Language: English. Entry Date: 20160820. Revision Date: 20160903. Publication Type: journal article. Journal Subset: Biomedical; Peer Reviewed; USA. Instrumentation: Longitudinal Interval Follow-Up Evaluation (LIFE); Ferrans and Powers Quality of Life Index. NLM UID: 7603616. KW - Breast Neoplasms -- Radiotherapy KW - Heart -- Radiation Effects KW - Proton Therapy -- Economics KW - Adult KW - Sensitivity and Specificity KW - Cost Benefit Analysis KW - Probability KW - Radiation Injuries -- Prevention and Control KW - Risk Factors KW - Female KW - Costs and Cost Analysis -- Methods KW - Coronary Disease -- Complications KW - Costs and Cost Analysis -- Economics KW - Catheterization KW - Quality of Life KW - Radiation Dosage KW - Quality-Adjusted Life Years KW - Models, Statistical KW - Body Regions -- Radiation Effects KW - Aged KW - Age Factors KW - Life Expectancy KW - Middle Age KW - Decision Support Systems, Clinical KW - Proton Therapy -- Adverse Effects KW - Ferrans and Powers Quality of Life Index SP - 11 EP - 18 JO - International Journal of Radiation Oncology, Biology, Physics JF - International Journal of Radiation Oncology, Biology, Physics JA - INT J RADIAT ONCOL BIOL PHYS VL - 95 IS - 1 PB - Pergamon Press - An Imprint of Elsevier Science AB - Purpose: Cardiac toxicity due to conventional breast radiation therapy (RT) has been extensively reported, and it affects both the life expectancy and quality of life of affected women. Given the favorable oncologic outcomes in most women irradiated for breast cancer, it is increasingly paramount to minimize treatment side effects and improve survivorship for these patients. Proton RT offers promise in limiting heart dose, but the modality is costly and access is limited. Using cost-effectiveness analysis, we provide a decision-making tool to help determine which breast cancer patients may benefit from proton RT referral.Methods and Materials: A Markov cohort model was constructed to compare the cost-effectiveness of proton versus photon RT for breast cancer management. The model was analyzed for different strata of women based on age (40 years, 50 years, and 60 years) and the presence or lack of cardiac risk factors (CRFs). Model entrants could have 1 of 3 health states: healthy, alive with coronary heart disease (CHD), or dead. Base-case analysis assumed CHD was managed medically. No difference in tumor control was assumed between arms. Probabilistic sensitivity analysis was performed to test model robustness and the influence of including catheterization as a downstream possibility within the health state of CHD.Results: Proton RT was not cost-effective in women without CRFs or a mean heart dose (MHD) <5 Gy. Base-case analysis noted cost-effectiveness for proton RT in women with ≥1 CRF at an approximate minimum MHD of 6 Gy with a willingness-to-pay threshold of $100,000/quality-adjusted life-year. For women with ≥1 CRF, probabilistic sensitivity analysis noted the preference of proton RT for an MHD ≥5 Gy with a similar willingness-to-pay threshold.Conclusions: Despite the cost of treatment, scenarios do exist whereby proton therapy is cost-effective. Referral for proton therapy may be cost-effective for patients with ≥1 CRF in cases for which photon plans are unable to achieve an MHD <5 Gy. SN - 0360-3016 AD - Department of Radiation Oncology, NYU School of Medicine, New York, New York AD - Radiation Oncology Program, Harvard University, Boston, Massachusetts AD - Department of Radiation Oncology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts AD - Cardiovascular Research Center, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts AD - Department of Radiation Oncology, University of Texas Southwestern Medical Center, San Antonio, Texas U2 - PMID: 27084617. DO - 10.1016/j.ijrobp.2016.02.031 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=114495808&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 114603320 T1 - Benefits and Harms of Screening Mammography by Comorbidity and Age: A Qualitative Synthesis of Observational Studies and Decision Analyses. AU - Braithwaite, Dejana AU - Walter, Louise AU - Izano, Monika AU - Kerlikowske, Karla AU - Walter, Louise C Y1 - 2016/05// N1 - Accession Number: 114603320. Language: English. Entry Date: 20160831. Revision Date: 20170614. Publication Type: journal article; research. Journal Subset: Biomedical; Continental Europe; Europe. Instrumentation: Death Anxiety Scale (DAS) (Templer). Grant Information: K24 AG041180/AG/NIA NIH HHS/United States. NLM UID: 8605834. KW - Early Detection of Cancer -- Methods KW - Breast Neoplasms KW - Mammography -- Adverse Effects KW - Human KW - Health Screening -- Methods KW - Age Factors KW - Cost Benefit Analysis KW - Early Detection of Cancer -- Adverse Effects KW - Health Screening -- Adverse Effects KW - Decision Support Techniques KW - Comorbidity KW - Female KW - Validation Studies KW - Comparative Studies KW - Evaluation Research KW - Multicenter Studies KW - Death Anxiety Scale SP - 561 EP - 572 JO - JGIM: Journal of General Internal Medicine JF - JGIM: Journal of General Internal Medicine JA - J GEN INTERN MED VL - 31 IS - 5 CY - , PB - Springer Science & Business Media B.V. AB - Objective: We conducted a systematic review to assess the quality and limitations of published studies examining benefits and harms of screening mammography in relation to comorbidity and age.Methods: We searched MEDLINE and EMBASE from January 1980 through June 2013 for studies that examined benefits or harms of screening mammography in women aged 65 years or older in relation to comorbidity. For each study, we extracted data regarding setting, design, quality, screening schedule, measure of comorbidity, and estimates of benefits and/or harms. We reviewed 1760 titles, identifying 7 articles that met the inclusion criteria: prospective cohort (two studies), retrospective cohort (two studies), and decision analyses (three studies). No randomized controlled trials were identified.Results: At least one measure of life expectancy or reduction in the risk of breast cancer death as a marker of benefit was examined in four studies, whereas three studies addressed the harms of screening mammography, including false-positive results. Both cohort studies and decision analyses showed that screening benefits decreased with increasing age and comorbidity burden.Conclusions: The limited evidence currently available suggests that, apart from older women with severe comorbidity, women 65 and older may experience improvements in life expectancy from screening. Given the potential for harm, it is unclear whether the magnitude of the benefit is sufficient to warrant regular screening. Women, clinicians and policymakers should consider these factors in deciding whether continue screening. SN - 0884-8734 AD - Department of Epidemiology and Biostatistics, University of California, San Francisco USA AD - Division of Geriatrics, San Francisco VA Medical Center and the University of California, San Francisco USA AD - Division of Geriatrics, San Francisco VA Medical Center and the University of California, San Francisco, CA, USA U2 - PMID: 26831305. DO - 10.1007/s11606-015-3580-3 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=114603320&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 114755748 T1 - Parental Decision Making Regarding the Disclosure or Nondisclosure of a Mutation-Positive BRCA1/2 Test Result to Minors. AU - Seenandan-Sookdeo, Kendra-Ann I. AU - Hack, Thomas F. AU - Lobchuk, Michelle AU - Murphy, Leigh AU - Marles, Sandra Y1 - 2016/05// N1 - Accession Number: 114755748. Language: English. Entry Date: 20160427. Revision Date: 20170501. Publication Type: Article; research; tables/charts. Journal Subset: Core Nursing; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Nursing; Peer Reviewed; USA. Grant Information: This research was funded by Hack’s Canadian Breast Cancer Foundation (Prairies/ NWT) Chair in Psychosocial and Supportive Care Oncology Research, the Foundation for Registered Nurses of Manitoba, Inc., Graduate Award, the Marion Saydak Memorial Scholarship, and Lesley F. Degner’s Chair in Evidence-Based Nursing Practice Graduate Studies Tuition Award from the Canadian Institute of Health Research.. NLM UID: 7809033. KW - Parents KW - Decision Making KW - Truth Disclosure KW - Genes, BRCA KW - Mutation KW - Cancer Screening KW - Breast Neoplasms -- Familial and Genetic KW - Ovarian Neoplasms -- Familial and Genetic KW - Human KW - Qualitative Studies KW - Phenomenological Research KW - Canada KW - Child KW - Adolescence KW - Open-Ended Questionnaires KW - Semi-Structured Interview KW - Thematic Analysis KW - Female KW - Purposive Sample KW - Sample Size KW - Audiorecording KW - Adult KW - Middle Age KW - Aged KW - Life Experiences KW - Coding KW - Audit KW - Descriptive Statistics KW - Age Factors KW - Cognition KW - Emotional Maturity KW - Time Factors KW - Honesty KW - Health Knowledge KW - Funding Source SP - 330 EP - 341 JO - Oncology Nursing Forum JF - Oncology Nursing Forum JA - ONCOL NURS FORUM VL - 43 IS - 3 CY - Pittsburgh, Pennsylvania PB - Oncology Nursing Society AB - Purpose/Objectives: To gain insight into parental decision making regarding the disclosure or nondisclosure of a mutation-positive BRCA1/2 test result to minors. Research Approach: A qualitative study based on Heidegger hermeneutic phenomenology was undertaken to explore the lived experience of parental decision making regarding high-risk BRCA1/2 disclosure. Setting: The study's recruitment site was a western Canadian hereditary breast and ovarian cancer clinic. Participants: Fifteen female mutation-positive BRCA1/2 carriers who had at least one child aged 6-18 years. Methodologic Approach: The use of a demographic questionnaire, semistructured interviews, and conversation summaries were employed to gain an understanding of participants' lived experience. van Manen's selective approach was used to conduct a thematic analysis. Findings: Collectively, parents wanted clinicians to discuss implications of disclosing and not disclosing a mutation-positive BRCA1/2 test result to minors in greater detail. The findings were categorized under the following emergent themes: influential factors, parental decision making, supportive resources, the inner circle, knowledge deficit, and parental recommendations. Conclusions: Participants' stories identified the need for auxiliary support pertaining to the decision-making process and suggested ways in which parental support may be coordinated. Interpretation: Oncology nurses with advanced genetics training should assist mutationpositive BRCA1/2 carriers in meeting their genetic risk information needs; this requires nurses to stay informed about a multitude of issues that affect this population of patients. SN - 0190-535X AD - Adjunct nursing faculty member, Faculty of Nursing, Minneapolis Community and Technical College, Minnesota AD - Professor, College of Nursing, University of Manitoba, Winnipeg, Canada AD - Associate professor and Manitoba Research Chair in Caregiver Communication, College of Nursing and Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada AD - Professor, Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Canada AD - Clinical geneticist, Health Sciences Centre, Winnipeg, Manitoba, Canada DO - 10.1188/16.ONF.330-341 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=114755748&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 114458147 T1 - When do cancer patients regret their treatment decision? A path analysis of the influence of clinicians' communication styles and the match of decision-making styles on decision regret. AU - Nicolai, Jennifer AU - Buchholz, Angela AU - Seefried, Nathalie AU - Reuter, Katrin AU - Härter, Martin AU - Eich, Wolfgang AU - Bieber, Christiane Y1 - 2016/05// N1 - Accession Number: 114458147. Language: English. Entry Date: In Process. Revision Date: 20170413. Publication Type: journal article; research; randomized controlled trial. Journal Subset: Core Nursing; Europe; Health Promotion/Education; Nursing; Peer Reviewed; UK & Ireland. Special Interest: Evidence-Based Practice. Instrumentation: Ways of Coping Questionnaire (WCQ) (Folkman et al); Perceived Stress Scale (PSS) (Cohen et al). NLM UID: 8406280. KW - Physician-Patient Relations KW - Breast Neoplasms -- Therapy KW - Empathy KW - Emotions KW - Colonic Neoplasms -- Therapy KW - Consumer Participation -- Psychosocial Factors KW - Patient Satisfaction KW - Patient Satisfaction -- Statistics and Numerical Data KW - Communication KW - Decision Making KW - Aged, 80 and Over KW - Human KW - Breast Neoplasms -- Psychosocial Factors KW - Male KW - Perception KW - Prospective Studies KW - Colonic Neoplasms -- Psychosocial Factors KW - Referral and Consultation KW - Consumer Participation -- Statistics and Numerical Data KW - Middle Age KW - Adult KW - Female KW - Treatment Outcomes KW - Validation Studies KW - Comparative Studies KW - Evaluation Research KW - Multicenter Studies KW - Randomized Controlled Trials KW - Scales KW - Ways of Coping Questionnaire SP - 739 EP - 746 JO - Patient Education & Counseling JF - Patient Education & Counseling JA - PATIENT EDUC COUNS VL - 99 IS - 5 PB - Elsevier B.V. AB - Objective: To test the influence of physician empathy (PE), shared decision making (SDM), and the match between patients' preferred and perceived decision-making styles on patients' decision regret.Methods: Patients with breast or colon cancer (n=71) completed questionnaires immediately following (T1) and three months after a consultation (T2). Path analysis was used to examine the relationships among patient demographics, patient reports of PE, SDM, the match between preferred and perceived decision-making styles, and patient decision regret at T2.Results: After controlling for clinician clusters, higher PE was directly associated with more SDM (β=0.43, p<0.01) and lower decision regret (β=-0.28, p<0.01). The match between patients' preferred and perceived roles was negatively associated with decision regret (β=-0.33, p<0.01). Patients who participated less than desired reported more decision regret at T2. There was no significant association between SDM and decision regret (β=0.03, p=0.74).Conclusion: PE and the match between patients' preferred and perceived roles in medical decision making are essential for patient-centered cancer consultations and treatment decisions.Practice Implications: Ways to enhance PE and matching the consultation style to patients' expectations should be encouraged. SN - 0738-3991 AD - Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital Heidelberg, Germany AD - Psychology III, University of Mannheim, Germany AD - Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany AD - Department of Psychiatry and Psychotherapy, University of Freiburg, Germany U2 - PMID: 26658703. DO - 10.1016/j.pec.2015.11.019 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=114458147&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 113538894 T1 - Predicting women's intentions for contralateral prophylactic mastectomy: An application of an extended theory of planned behaviour. AU - Richards, Imogen AU - Tesson, Stephanie AU - Porter, David AU - Phillips, Kelly-Anne AU - Rankin, Nicole AU - Musiello, Toni AU - Marven, Michelle AU - Butow, Phyllis Y1 - 2016/04// N1 - Accession Number: 113538894. Language: English. Entry Date: 20160316. Revision Date: 20160413. Publication Type: Article; research. Journal Subset: Core Nursing; Europe; Nursing; Peer Reviewed; UK & Ireland. Special Interest: Women's Health. NLM UID: 100885136. KW - Decision Making, Patient KW - Mastectomy KW - Breast Neoplasms -- Prevention and Control KW - Patient Attitudes -- Evaluation KW - Surgery, Elective KW - Human KW - Female KW - Vignettes KW - Questionnaires KW - Internet -- Utilization KW - Ajzen's Theory of Planned Behavior KW - Uncertainty KW - Self-Efficacy KW - Descriptive Statistics KW - Predictive Research SP - 57 EP - 65 JO - European Journal of Oncology Nursing JF - European Journal of Oncology Nursing JA - EUR J ONCOL NURS VL - 21 PB - Churchill Livingstone, Inc. AB - Purpose Most women with unilateral breast cancer (BC) without BRCA1/2 gene mutations are at low risk of contralateral breast cancer (CBC). One CBC risk-management option is contralateral prophylactic mastectomy (CPM). While there is no evidence that CPM increases life-expectancy, its uptake is increasing. This study aimed to assess the validity of an extended social-cognition model, the Theory of Planned Behaviour (TPB), in predicting women's intentions to undergo CPM. Method Four hundred women previously treated for BC completed an online survey exploring demographic and disease factors, attitude, subjective norm, perceived behavioural control, anticipated regret, uncertainty avoidance, self-efficacy to not have CPM and intentions to undergo CPM in a common hypothetical decision-making scenario. Results The TPB uniquely explained 25.7% of intention variance. Greater anticipated regret, uncertainty avoidance and lower self-efficacy to cope with not having CPM were associated with stronger CPM intentions, explaining an additional 7.7%, 10.6% and 2.9% respectively, of variance over and above the TPB. Women who had undergone CPM, had not attended university, and had children reported stronger CPM intentions. Conclusions A holistic understanding of CPM decision-making appears to require consideration beyond CBC risk, demographics and disease characteristics, exploring women's expectations about CPM outcomes, others' opinions, and avoidance of emotionality and difficulties associated with not undergoing surgery. This study provides a theoretical basis from which the complexity of CPM decision-making may be understood, and from which resources for patients and treating staff may be developed to support women's informed decision-making aligning with their personal values. SN - 1462-3889 AD - School of Psychology, Griffith Taylor Building (A19), The University of Sydney, NSW 2006, Australia AD - Department of Oncology, Auckland City Hospital, 2 Park Road, Grafton, Auckland 1023, New Zealand AD - Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia AD - Sir Peter MacCallum Dept. of Oncology, Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, School of Population and Global Health, Locked Bag 1, A'Beckett Street, VIC 8006, Australia AD - Department of Medicine, St Vincent's Hospital, The University of Melbourne, Level 4, Clinical Sciences Building, 29 Regent St, Fitzroy, VIC 3065, Australia AD - Sydney Catalyst, Level 6, Chris O'Brien Lifehouse Building (C39Z), Sydney, NSW 2006, Australia AD - University of Western Australia (M507), 35 Stirling Highway, Crawley, WA 6009, Australia AD - Breast Cancer Network Australia, 293 Camberwell Rd, Camberwell, VIC 3124, Australia AD - Centre for Medical Psychology & Evidence-based Decision Making/Psycho-oncology Co-operative Research Group, Level 6, Chris O'Brien Lifehouse Building (C39Z), Sydney, NSW 2006, Australia DO - 10.1016/j.ejon.2015.12.002 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=113538894&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 113451339 T1 - Lessons Learned from a Cross-Model Validation between a Discrete Event Simulation Model and a Cohort State-Transition Model for Personalized Breast Cancer Treatment. AU - Jahn, Beate AU - Rochau, Ursula AU - Kurzthaler, Christina AU - Paulden, Mike AU - Kluibenschädl, Martina AU - Arvandi, Marjan AU - Kühne, Felicitas AU - Goehler, Alexander AU - Krahn, Murray D. AU - Siebert, Uwe Y1 - 2016/04// N1 - Accession Number: 113451339. Language: English. Entry Date: In Process. Revision Date: 20160311. Publication Type: Article. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 8109073. SP - 375 EP - 390 JO - Medical Decision Making JF - Medical Decision Making JA - MED DECIS MAKING VL - 36 IS - 3 CY - Thousand Oaks, California PB - Sage Publications Inc. AB - Objectives. Breast cancer is the most common malignancy among women in developed countries. We developed a model (the Oncotyrol breast cancer outcomes model) to evaluate the cost-effectiveness of a 21-gene assay when used in combination with Adjuvant! Online to support personalized decisions about the use of adjuvant chemotherapy. The goal of this study was to perform a cross-model validation. Methods. The Oncotyrol model evaluates the 21-gene assay by simulating a hypothetical cohort of 50-year-old women over a lifetime horizon using discrete event simulation. Primary model outcomes were life-years, quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs). We followed the International Society for Pharmacoeconomics and Outcomes Research–Society for Medical Decision Making (ISPOR-SMDM) best practice recommendations for validation and compared modeling results of the Oncotyrol model with the state-transition model developed by the Toronto Health Economics and Technology Assessment (THETA) Collaborative. Both models were populated with Canadian THETA model parameters, and outputs were compared. Results. The differences between the models varied among the different validation end points. The smallest relative differences were in costs, and the greatest were in QALYs. All relative differences were less than 1.2%. The cost-effectiveness plane showed that small differences in the model structure can lead to different sets of nondominated test-treatment strategies with different efficiency frontiers. We faced several challenges: distinguishing between differences in outcomes due to different modeling techniques and initial coding errors, defining meaningful differences, and selecting measures and statistics for comparison (means, distributions, multivariate outcomes). Conclusions. Cross-model validation was crucial to identify and correct coding errors and to explain differences in model outcomes. In our comparison, small differences in either QALYs or costs led to changes in ICERs because of changes in the set of dominated and nondominated strategies. SN - 0272-989X AD - Department of Radiology, Yale University, New Haven, CT, USA (AG) AD - Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA (AG) AD - Alfried Krupp von Bohlen und Halbach Foundation—Institute for Health Systems Management, University of Duisburg-Essen, Essen, Germany (AG) AD - Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (US) AD - Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto, ON, Canada (MP, MK) AD - Center for Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA (US) AD - Department of Emergency Medicine; University of Alberta, Edmonton, AB, Canada (MP) AD - Division of Public Health Decision Modelling, Health Technology Assessment and Health Economics, ONCOTYROL—Center for Personalized Cancer Medicine, Innsbruck, Austria (BJ, UR, CK, MK, MS, FK, US) AD - Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health and Health Technology Assessment, UMIT—University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria (BJ, UR, CK, MK, MA, MS, FK, AG, US) DO - 10.1177/0272989X15604158 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=113451339&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 113840930 T1 - Evaluating a Decision Aid for Improving Decision Making in Patients with Early-stage Breast Cancer. AU - Hawley, Sarah AU - Newman, Lisa AU - Griggs, Jennifer AU - Kosir, Mary AU - Katz, Steven Y1 - 2016/04// N1 - Accession Number: 113840930. Language: English. Entry Date: 20160328. Revision Date: 20160328. Publication Type: Article; research; tables/charts. Journal Subset: Europe; Health Services Administration; UK & Ireland. Special Interest: Oncologic Care; Women's Health. Grant Information: This work was funded by Grant Number R21 CA129859 to the University of Michigan.. NLM UID: 101309314. KW - Decision Support Techniques -- Evaluation KW - Patient Education -- Methods KW - Decision Making, Patient KW - Breast Neoplasms -- Therapy KW - Human KW - Pilot Studies KW - Patients KW - Female KW - Questionnaires KW - T-Tests KW - Chi Square Test KW - Adult KW - Middle Age KW - Aged KW - Aged, 80 and Over KW - Funding Source SP - 161 EP - 169 JO - Patient JF - Patient JA - PATIENT VL - 9 IS - 2 PB - Springer Science & Business Media B.V. SN - 1178-1653 AD - Department of Surgery, University of Michigan, Ann Arbor USA AD - Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, 4th Floor Ann Arbor 48109 USA AD - Karmanos Cancer Institute, Detroit USA DO - 10.1007/s40271-015-0135-y UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=113840930&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 113798842 T1 - Cost-Effectiveness of Pertuzumab in Human Epidermal Growth Factor Receptor 2-Positive Metastatic Breast Cancer. AU - Durkee, Ben Y. AU - Yushen Qian AU - Pollom, Erqi L. AU - King, Martin T. AU - Dudley, Sara A. AU - Shaffer, Jenny L. AU - Chang, Daniel T. AU - Gibbs, Iris C. AU - Goldhaber-Fiebert, Jeremy D. AU - Horst, Kathleen C. AU - Qian, Yushen Y1 - 2016/03/20/ N1 - Accession Number: 113798842. Language: English. Entry Date: 20160713. Revision Date: 20170424. Publication Type: journal article; research; randomized controlled trial. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Evidence-Based Practice. Instrumentation: Clinical Decision Making in Nursing Scale (CDMNS) (Jenkins); Longitudinal Interval Follow-Up Evaluation (LIFE); Ferrans and Powers Quality of Life Index. Grant Information: K01AG037593-01A1/AG/NIA NIH HHS/United States. NLM UID: 8309333. KW - Breast Neoplasms -- Drug Therapy KW - Antineoplastic Agents, Combined -- Economics KW - Antibodies, Monoclonal -- Economics KW - Antibodies, Monoclonal -- Administration and Dosage KW - Antineoplastic Agents, Combined -- Administration and Dosage KW - Female KW - Human KW - Aged KW - Decision Support Techniques KW - Hydrocarbons -- Economics KW - Breast Neoplasms -- Economics KW - Receptors, Cell Surface KW - Breast Neoplasms KW - Models, Statistical KW - Probability KW - Neoplasm Invasiveness KW - Breast Neoplasms -- Pathology KW - Cost Benefit Analysis KW - United States KW - Middle Age KW - Hydrocarbons -- Administration and Dosage KW - Validation Studies KW - Comparative Studies KW - Evaluation Research KW - Multicenter Studies KW - Randomized Controlled Trials KW - Ferrans and Powers Quality of Life Index KW - Scales SP - 902 EP - 909 JO - Journal of Clinical Oncology JF - Journal of Clinical Oncology JA - J CLIN ONCOL VL - 34 IS - 9 CY - Alexandria, Virginia PB - American Society of Clinical Oncology AB - Purpose: The Clinical Evaluation of Pertuzumab and Trastuzumab (CLEOPATRA) study showed a 15.7-month survival benefit with the addition of pertuzumab to docetaxel and trastuzumab (THP) as first-line treatment for patients with human epidermal growth factor receptor 2 (HER2) -overexpressing metastatic breast cancer. We performed a cost-effectiveness analysis to assess the value of adding pertuzumab. Patient and Methods: We developed a decision-analytic Markov model to evaluate the cost effectiveness of docetaxel plus trastuzumab (TH) with or without pertuzumab in US patients with metastatic breast cancer. The model followed patients weekly over their remaining lifetimes. Health states included stable disease, progressing disease, hospice, and death. Transition probabilities were based on the CLEOPATRA study. Costs reflected the 2014 Medicare rates. Health state utilities were the same as those used in other recent cost-effectiveness studies of trastuzumab and pertuzumab. Outcomes included health benefits expressed as discounted quality-adjusted life-years (QALYs), costs in US dollars, and cost effectiveness expressed as an incremental cost-effectiveness ratio. One- and multiway deterministic and probabilistic sensitivity analyses explored the effects of specific assumptions. Results: Modeled median survival was 39.4 months for TH and 56.9 months for THP. The addition of pertuzumab resulted in an additional 1.81 life-years gained, or 0.62 QALYs, at a cost of $472,668 per QALY gained. Deterministic sensitivity analysis showed that THP is unlikely to be cost effective even under the most favorable assumptions, and probabilistic sensitivity analysis predicted 0% chance of cost effectiveness at a willingness to pay of $100,000 per QALY gained. Conclusion: THP in patients with metastatic HER2-positive breast cancer is unlikely to be cost effective in the United States. SN - 0732-183X AD - Stanford University School of Medicine AD - Stanford University, Stanford CA AD - Ben Y. Durkee, Yushen Qian, Erqi L. Pollom, Martin T. King, Sara A. Dudley, Jenny L. Shaffer, Daniel T. Chang, Iris C. Gibbs, and Kathleen C. Horst, Stanford University School of Medicine; and Jeremy D. Goldhaber-Fiebert, Stanford University, Stanford CA U2 - PMID: 26351332. DO - 10.1200/JCO.2015.62.9105 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=113798842&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 113222875 T1 - Challenging Breast Augmentations: The Influence of Preoperative Anatomical Features on the Final Result. AU - Bayram, Yalcin AU - Zor, Fatih AU - Karagoz, Huseyin AU - Kulahci, Yalcin AU - Afifi, Ahmed M. AU - Ozturk, Serdar Y1 - 2016/03//03/01/2016 N1 - Accession Number: 113222875. Language: English. Entry Date: 20160826. Revision Date: 20170307. Publication Type: journal article. Journal Subset: Biomedical; Mexico & Central/South America; Peer Reviewed. Instrumentation: Arthritis Impact Measurement Scale (AIMS) (Meenan); Impact of Events Scale (IES). NLM UID: 9707469. KW - Breast Implants -- Equipment and Supplies KW - Breast -- Surgery KW - Breast Implants -- Adverse Effects KW - Risk Factors KW - Photography KW - Retrospective Design KW - Risk Assessment KW - Treatment Outcomes KW - Young Adult KW - Female KW - Breast Implants KW - Adult KW - Postoperative Complications -- Etiology KW - Breast -- Abnormalities KW - Decision Support Techniques KW - Patient Satisfaction KW - Arthritis Impact Measurement Scales KW - Impact of Events Scale SP - 313 EP - 320 JO - Aesthetic Surgery Journal JF - Aesthetic Surgery Journal JA - AESTHETIC SURG J VL - 36 IS - 3 PB - Oxford University Press / USA AB - Background: Achieving satisfactory results may be difficult in augmentation mammaplasty patients in the presence of breast, chest wall, or vertebral deformities. These deformities have not been classified previously, and the impact of each deformity or combination of deformities has not been defined.Objectives: The aims of this study are to determine the complicating factors in augmentation mammaplasty, to classify these factors according to their influence on surgical outcome, and to develop an identification system for simplifying the recognition of challenging cases.Methods: We retrospectively analyzed photographs and records of 100 consecutive patients who underwent augmentation mammaplasty. We observed suboptimal results in 18 cases. Preoperative deformities of the breast, chest wall, and vertebra were recorded in order to determine which factor or factors had complicated the surgeries. Eventually, the relationship between suboptimal surgical results and complicating factors was evaluated.Results: We observed that some deformities alone caused suboptimal results, whereas others did not. Deformities that caused suboptimal results alone were called major complicating factors, and any others were called minor complicating factors. We observed that suboptimal results were also obtained in patients who had four minor complicating factors. Patients who had suboptimal results because of major or minor complicating factors were considered challenging cases.Conclusions: In this study, complicating factors for augmentation mammaplasty were defined and classified as major or minor depending on their effect on the surgical outcome. We suggest an identification system that simplifies the recognition of challenging cases in breast augmentation. SN - 1090-820X AD - Associate Professors, Gulhane Military Medical Academy, Ankara, Turkey AD - Associate Professor, Department of Plastic, Reconstructive, and Aesthetic Surgery; GATA Haydarpasha Training Hospital, Istanbul, Turkey AD - Associate Professor, Department of Hand Surgery, Gulhane Military Medical Academy, Ankara, Turkey AD - Assistant Professor, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA AD - Professor, Department of Plastic, Reconstructive, and Aesthetic Surgery, Gulhane Military Medical Academy, Ankara, Turkey U2 - PMID: 26420774. DO - 10.1093/asj/sjv181 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=113222875&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 114135748 T1 - On Women's Ambivalence about Mammography Screening: Support in the Decision-Making Process a Potential Role for Health Care Social Workers? AU - Ritenius Manjer, Åsa AU - Zackrisson, Sophia AU - Emilsson, Ulla Melin Y1 - 2016/03// N1 - Accession Number: 114135748. Language: English. Entry Date: 20160404. Revision Date: 20170301. Publication Type: Article; algorithm; research; tables/charts. Journal Subset: Allied Health; Europe; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care; Women's Health. NLM UID: 1271641. KW - Breast Neoplasms -- Radiography KW - Mammography KW - Cancer Screening KW - Social Work KW - Decision Making KW - Human KW - Female KW - Professional Role KW - Semi-Structured Interview KW - Sweden KW - Thematic Analysis KW - Health Belief Model KW - Conceptual Framework KW - Qualitative Studies KW - Support, Psychosocial KW - Interview Guides KW - Social Workers SP - 480 EP - 497 JO - British Journal of Social Work JF - British Journal of Social Work JA - BR J SOC WORK VL - 46 IS - 2 PB - Oxford University Press / USA AB - The aim of this article is to reach a deeper understanding of women's decision-making process regarding non-attendance at mammography screenings. The article also discusses the health care social workers' role in providing support to women during this decision. Eighteen qualitative semi-structured interviews were conducted with women who had abstained from mammography screening in Malmo, Sweden. Thematic analyses were used as a method and The Rational Choice Theory, The Health Belief Model and the notion of Cross-Pressure were used as a theoretical framework. A prominent feature was that the relationship between the women's decision to abstain and the normative perception that mammography is an important examination led to ambivalent thoughts. It can be seen as an adjustment to the structure to be invited and a cross-pressure between performed and expected actions. Moreover, the decision to abstain from mammography screening was preceded by thoughts about the right choice, specifically in relation to what would happen to these women if they got breast cancer. Women who abstain need to think about their decision to a larger extent than women who attend the screening and we argue that they should be offered support by health care social workers in the invitation letter to mammography screening. SN - 0045-3102 AD - School of Social Work, Lund University, Lund, Sweden AD - Department of Clinical Sciences Malmo, Diagnostic Radiology, Lund University, Malmö, Sweden DO - 10.1093/bjsw/bcu078 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=114135748&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 115072729 T1 - Decision Control, Support a Key in Early Breast Cancer. Y1 - 2016///Spring2016 N1 - Accession Number: 115072729. Language: English. Entry Date: In Process. Revision Date: 20160505. Publication Type: Article. Journal Subset: Nursing; USA. SP - 18 EP - 18 JO - Johns Hopkins Nursing JF - Johns Hopkins Nursing JA - JOHNS HOPKINS NURS VL - 14 IS - 1 CY - Baltimore, Maryland PB - Johns Hopkins University UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=115072729&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 112829187 T1 - The importance of enabling informed decision making for women considering breast cancer screening...Sasieni PD, Smith RA and Duffy SW. Informed decision-making and breast cancer screening. J Med Screen. 2015. AU - Hersch, Jolyn AU - Barratt, Alexandra AU - Jansen, Jesse AU - Irwig, Les AU - McGeechan, Kevin AU - Jacklyn, Gemma AU - Thornton, Hazel AU - Dhillon, Haryana AU - Houssami, Nehmat AU - McCaffery, Kirsten Y1 - 2016/03// N1 - Accession Number: 112829187. Language: English. Entry Date: 20170818. Revision Date: 20170818. Publication Type: Article; commentary; letter. Journal Subset: Biomedical; Editorial Board Reviewed; Europe; Peer Reviewed; UK & Ireland. NLM UID: 9433359. KW - Breast Neoplasms KW - Cancer Screening KW - Decision Making KW - Health Knowledge SP - 55 EP - 55 JO - Journal of Medical Screening JF - Journal of Medical Screening JA - J MED SCREEN VL - 23 IS - 1 PB - Sage Publications, Ltd. AB - The article presents the authors' response to comments by PD Sasieni et al on their Lancel report of a randomised controlled trial of a breast screening decision aid. They point out that in a modern healthcare system, women must have the opportunity to make an informed choice on whether to undergo breast screening supported by balanced, objective information and that it is an ethical responsibility to alert women to the risk of harm through overdetection. SN - 0969-1413 AD - Screening & Test Evaluation Program (STEP), School of Public Health, The University of Sydney, Australia AD - Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), The University of Sydney, Australia AD - Department of Health Sciences, University of Leicester, UK DO - 10.1177/0969141315612818 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=112829187&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 113183910 T1 - Beliefs in Chemotherapy and Knowledge of Cancer and Treatment Among African American Women With Newly Diagnosed Breast Cancer. AU - Yun Jiang AU - Sereika, Susan M. AU - Bender, Catherine M. AU - Brufsky, Adam M. AU - Rosenzweig, Margaret Q. Y1 - 2016/03// N1 - Accession Number: 113183910. Language: English. Entry Date: 20160224. Revision Date: 20170301. Publication Type: Article; research; tables/charts. Journal Subset: Core Nursing; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Nursing; Peer Reviewed; USA. Instrumentation: General Self-Efficacy Scale (GSE); Symptom Distress Scale (SDS) (McCorkle and Young); Health Care System Distrust Scale; Beliefs about Medicines Questionnaire (BMQ; Tumor and Treatment Knowledge Assessment; Medical Effectiveness Research Center Interpersonal Processes of Care (MERC IPC); 27-item Functional Assessment of Cancer Therapy. NLM UID: 7809033. KW - Health Beliefs -- Evaluation KW - Breast Neoplasms -- Drug Therapy KW - Health Knowledge KW - Blacks KW - Chemotherapy, Cancer -- Methods KW - Breast Neoplasms -- Diagnosis KW - Patient Attitudes -- Evaluation KW - Human KW - Female KW - Descriptive Research KW - Descriptive Statistics KW - Cross Sectional Studies KW - Cancer Care Facilities KW - Urban Areas KW - Pennsylvania KW - Ohio KW - Secondary Analysis KW - Repeated Measures KW - Psychoeducation KW - Self-Efficacy KW - Quality of Life KW - Variable KW - Cancer Patients KW - Chemotherapy, Cancer -- Education KW - Questionnaires KW - Summated Rating Scaling KW - Scales KW - Symptom Distress Scale KW - Coefficient Alpha KW - Data Analysis Software KW - Mann-Whitney U Test KW - Multiple Linear Regression KW - Aged KW - Educational Status KW - Employment Status KW - Marital Status SP - 180 EP - 189 JO - Oncology Nursing Forum JF - Oncology Nursing Forum JA - ONCOL NURS FORUM VL - 43 IS - 2 CY - Pittsburgh, Pennsylvania PB - Oncology Nursing Society AB - Purpose/Objectives: To examine beliefs regarding the necessity of chemotherapy and knowledge of breast cancer and its treatment in African American women with newly diagnosed breast cancer, and to explore factors associated with women's beliefs and knowledge. Design: Descriptive, cross-sectional study. Setting: Six urban cancer centers in Western Pennsylvania and Eastern Ohio. Sample: 101 African American women with newly diagnosed breast cancer. Methods: Secondary analysis using baseline data collected from participants in a randomized, controlled trial at their first medical oncology visit before the first cycle of chemotherapy. Main Research Variables: Belief in chemotherapy, knowledge of cancer and recommended treatment, self-efficacy, healthcare system distrust, interpersonal processes of care, symptom distress, and quality of life. Findings: African American women endorsed the necessity of chemotherapy. Most women did not know their tumor size, hormone receptors, specific therapy, or why chemotherapy was recommended to them. Women who perceived better interpersonal communication with physicians, less self-efficacy, or were less involved in their own treatment decision making held stronger beliefs about the necessity of chemotherapy. Women without financial difficulty or having stronger social functioning had more knowledge of their cancer and recommended chemotherapy. Conclusions: African American women with newly diagnosed breast cancer generally agreed with the necessity of chemotherapy. Knowledge of breast cancer, treatment, and risk reduction through adjuvant therapy was limited. Implications for Nursing: Oncology nurses could help advocate for tailored educational programs to support informed decision making regarding chemotherapy acceptance for African American women. SN - 0190-535X AD - research fellow, Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor AD - professor, School of Nursing and director, Center for Research and Evaluation, Department of Health and Community Systems, University of Pittsburgh, Pennsylvania AD - professor, School of Nursing and PhD program director, University of Pittsburgh, Pennsylvania AD - professor, School of Medicine, University of Pittsburgh, Pennsylvania AD - associate professor, School of Nursing, University of Pittsburgh, Pennsylvania DO - 10.1188/16.ONF.180-189 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=113183910&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 112332979 T1 - The acceptability of PEGASUS: an intervention to facilitate shared decision-making with women contemplating breast reconstruction. AU - Harcourt, Diana AU - Griffiths, Catrin AU - Baker, Elisabeth AU - Hansen, Esther AU - White, Paul AU - Clarke, Alex Y1 - 2016/03// N1 - Accession Number: 112332979. Language: English. Entry Date: 20160126. Revision Date: 20170823. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. Grant Information: We would like to thank Breast Cancer Campaign for funding this study [ref 2011MaySP25],members of the PEGASUS advisory group and the patients and health professionals at the RoyalFree Hospital who took part.. NLM UID: 9604099. KW - Program Evaluation KW - Breast Reconstruction KW - Decision Making KW - Questionnaires KW - Feedback KW - Human KW - Female KW - Adult KW - Middle Age KW - Aged KW - Descriptive Statistics KW - Data Analysis Software KW - Funding Source SP - 248 EP - 253 JO - Psychology, Health & Medicine JF - Psychology, Health & Medicine JA - PSYCHOL HEALTH MED VL - 21 IS - 2 CY - Oxfordshire, PB - Routledge AB - Good practice guidelines recommend that women who undergo mastectomy are offered reconstructive surgery. However, many who choose this option report a degree of decisional regret and dissatisfaction because their pre-surgical expectations were not met. This paper reports an acceptability study of a new intervention (PEGASUS) that aims to support shared decision-making by eliciting women’s pre-surgical expectations and setting patient-centred goals. Eighteen women contemplating breast reconstruction completed the PEGASUS intervention. Semi-structured interviews were conducted with 12 women and 3 health professionals to explore their experiences of using PEGASUS. Interview transcripts were subjected to a thematic analysis, and a content analysis was conducted on 79 goals that the 18 women identified. Feedback was extremely positive – women found that completing PEGASUS alongside a discussion with a specially trained health professional helped them prepare for the surgical consultation and increased their trust in their surgeon. Staff reported that PEGASUS facilitated patient-centred discussions and informed the decisions made about potential surgery. This preliminary study suggests that this novel intervention is acceptable to patients and health professionals alike. Further work is needed to evaluate its efficacy and then its effectiveness with a larger sample of women, and its potential use with other patient groups. SN - 1354-8506 AD - Centre for Appearance Research, University of the West of England, Bristol, UK AD - Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK AD - Department of Engineering, Design and Mathematics, University of the West of England, Bristol, UK DO - 10.1080/13548506.2015.1051059 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=112332979&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 112053444 T1 - Exploring patient experiences of neo-adjuvant chemotherapy for breast cancer. AU - Beaver, Kinta AU - Williamson, Susan AU - Briggs, Jean Y1 - 2016/02// N1 - Accession Number: 112053444. Language: English. Entry Date: 20160309. Revision Date: 20160309. Publication Type: Article; research. Journal Subset: Core Nursing; Europe; Nursing; Peer Reviewed; UK & Ireland. NLM UID: 100885136. KW - Breast Neoplasms -- Therapy KW - Chemotherapy, Adjuvant KW - Oncologic Nursing KW - Human KW - Female KW - Qualitative Studies KW - Interviews KW - Thematic Analysis KW - Information Needs KW - Decision Making, Patient KW - Support, Psychosocial KW - Adult KW - Coping KW - Referral and Consultation SP - 77 EP - 86 JO - European Journal of Oncology Nursing JF - European Journal of Oncology Nursing JA - EUR J ONCOL NURS VL - 20 PB - Churchill Livingstone, Inc. AB - Background and purpose Neo-adjuvant chemotherapy is recommended for ‘inoperable’ locally advanced and inflammatory breast cancers. For operable breast cancers, trials indicate no survival differences between chemotherapy given pre or post-surgery. Communicating evidence based information to patients is complex and studies examining patient experiences of neo-adjuvant chemotherapy are lacking. This study aims to explore the experiences of women who received neo-adjuvant chemotherapy for breast cancer. Methods A qualitative approach using in-depth interviews with 20 women who had completed neo-adjuvant chemotherapy for breast cancer. Interview data were analysed using thematic analysis. Results The sample included a relatively young group of women, with caring responsibilities. Five main themes emerged: coping with the rapid transition from ‘well’ to ‘ill’, information needs and decision making, needing support and empathy, impact on family, and creating a new ‘normal’. More support was needed towards the end of chemotherapy, when side effects were at their most toxic, and decisions about forthcoming surgery were being made. Some women were referred to psychological services, but usually when a crisis point had been reached. Conclusion Information and support would have been beneficial at key time points. This information is vital in developing services and interventions to meet the complex needs of these patients and potentially prevent late referral to psychological services. Specialist oncology nurses are able to develop empathetic relationships with patients and have the experience, knowledge and skills to inform and support women experiencing neo-adjuvant chemotherapy. Targeting key time points and maintaining relationship throughout neo-adjuvant chemotherapy would be highly beneficial. SN - 1462-3889 AD - School of Health, University of Central Lancashire, Preston, UK AD - Department of Clinical Psychology, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK DO - 10.1016/j.ejon.2015.06.001 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=112053444&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 113310201 T1 - Cancer Models and Real-world Data: Better Together. AU - Kim, Jane J. AU - Tosteson, Anna NA AU - Zauber, Ann G. AU - Sprague, Brian L. AU - Stout, Natasha AU - Alagoz, Oguzhan AU - Trentham-Dietz, Amy AU - Armstrong, Katrina AU - Pruitt, Sandi AU - Rutter, Carolyn M. AU - Stout, Natasha K AU - Pruitt, Sandi L Y1 - 2016/02// N1 - Accession Number: 113310201. Corporate Author: Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium. Language: English. Entry Date: 20160228. Revision Date: 20170208. Publication Type: journal article. Journal Subset: Biomedical; Peer Reviewed; USA. Instrumentation: Clinical Decision Making in Nursing Scale (CDMNS) (Jenkins). Grant Information: U54 CA164336/CA/NCI NIH HHS/United States. NLM UID: 7503089. KW - Cancer Care Facilities -- Statistics and Numerical Data KW - Decision Support Techniques KW - Health Screening -- Trends KW - Health Screening -- Standards KW - Neoplasms -- Diagnosis KW - Neoplasms -- Epidemiology KW - Patient Attitudes KW - Early Detection of Cancer -- Trends KW - Early Detection of Cancer -- Standards KW - Colorectal Neoplasms -- Epidemiology KW - Prostatic Neoplasms -- Diagnosis KW - Prostatic Neoplasms -- Epidemiology KW - Practice Guidelines KW - National Cancer Institute (U.S.) KW - Male KW - Female KW - United States KW - Colorectal Neoplasms -- Diagnosis KW - Research Support KW - Breast Neoplasms -- Diagnosis KW - Breast Neoplasms -- Epidemiology KW - Scales SP - 1 EP - 5 JO - JNCI: Journal of the National Cancer Institute JF - JNCI: Journal of the National Cancer Institute JA - J NATL CANCER INST VL - 108 IS - 2 PB - Oxford University Press / USA AB - Decision-analytic models are increasingly used to inform health policy decisions. These models synthesize available data on disease burden and intervention effectiveness to project estimates of the long-term consequences of care, which are often absent when clinical or policy decisions must be made. While models have been influential in informing US cancer screening guidelines under ideal conditions, incorporating detailed data on real-world screening practice has been limited given the complexity of screening processes and behaviors throughout diverse health delivery systems in the United States. We describe the synergies that exist between decision-analytic models and health care utilization data that are increasingly accessible through research networks that assemble data from the growing number of electronic medical record systems. In particular, we present opportunities to enrich cancer screening models by grounding analyses in real-world data with the goals of projecting the harms and benefits of current screening practices, evaluating the value of existing and new technologies, and identifying the weakest links in the cancer screening process where efforts for improvement may be most productively focused. We highlight the example of the National Cancer Institute-funded consortium Population-based Research Optimizing Screening through Personalized Regimens (PROSPR), a collaboration to harmonize and analyze screening process and outcomes data on breast, colorectal, and cervical cancers across seven research centers. The pairing of models with such data can create more robust models to not only better inform policy but also inform health care systems about best approaches to improve the provision of cancer screening in the United States. SN - 0027-8874 AD - Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, AD - Department of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, AD - Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY AD - Department of Surgery and University of Vermont Cancer Center, University of Vermont, Burlington, VT (BLS); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, AD - Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI Population Health Sciences and Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI (ATD); Department of Medicine, Massachusetts General Hospital, Boston AD - Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (SLP); RAND Corporation, Santa Monica, CA AD - Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA (JJK); Department of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH (ANAT); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (AGZ); Department of Surgery and University of Vermont Cancer Center, University of Vermont, Burlington, VT (BLS); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI (OA); Population Health Sciences and Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI (ATD); Department of Medicine, Massachusetts General Hospital, Boston, MA (KA); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (SLP); RAND Corporation, Santa Monica, CA (CMR) U2 - PMID: 26538628. DO - 10.1093/jnci/djv316 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=113310201&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 112506105 T1 - Use of hypofractionated post-mastectomy radiotherapy reduces health costs by over $2000 per patient: An Australian perspective. AU - Mortimer, Joshua W AU - McLachlan, Craig S AU - Hansen, Carmen J AU - Assareh, Hassan AU - Last, Andrew AU - McKay, Michael J AU - Shakespeare, Thomas P Y1 - 2016/02// N1 - Accession Number: 112506105. Language: English. Entry Date: 20160826. Revision Date: 20170131. Publication Type: journal article; research. Journal Subset: Australia & New Zealand; Biomedical. Instrumentation: Clinical Decision Making in Nursing Scale (CDMNS) (Jenkins). NLM UID: 101469340. KW - Breast Neoplasms -- Economics KW - Breast Neoplasms -- Therapy KW - Radiotherapy, Adjuvant -- Economics KW - Prostatectomy -- Economics KW - Cost Savings -- Economics KW - Adult KW - Prostatectomy -- Utilization KW - Cost Savings -- Utilization KW - Australia KW - Aged, 80 and Over KW - Human KW - Prevalence KW - Female KW - Aged KW - Breast Neoplasms -- Epidemiology KW - Radiotherapy, Adjuvant -- Utilization KW - Retrospective Design KW - Health Care Costs -- Statistics and Numerical Data KW - Treatment Outcomes KW - Middle Age KW - Validation Studies KW - Comparative Studies KW - Evaluation Research KW - Multicenter Studies KW - Scales SP - 146 EP - 153 JO - Journal of Medical Imaging & Radiation Oncology JF - Journal of Medical Imaging & Radiation Oncology JA - J MED IMAGING RADIAT ONCOL VL - 60 IS - 1 CY - Malden, Massachusetts PB - Wiley-Blackwell AB - Introduction: The most recent clinical practice guidelines released by Cancer Australia draw attention to unanswered questions concerning the health economic considerations associated with hypofractionated radiotherapy. This study aimed to quantify and compare the healthcare costs at a regional Australian radiotherapy institute with respect to conventionally fractionated post-mastectomy radiotherapy (Cf-PMRT) versus hypofractionated post-mastectomy radiotherapy (Hf-PMRT) administration.Methods: Medical records of 196 patients treated with post-mastectomy radiotherapy at the NSW North Coast Cancer Institute from February 2008 to June 2014 were retrospectively reviewed. Australian Medicare item numbers billed for patients receiving either Cf-PMRT of 50 Gy in 25 daily fractions or Hf-PMRT of 40.05 Gy in 15 daily fractions were calculated. Decision tree analysis was used to model costs. Independent-samples t-tests and Mann-Whitney U-tests were used to compare crude average costs for Cf-PMRT and Hf-PMRT and determine which treatment components accounted for any differences.Results: Hf-PMRT, with or without irradiation to the regional lymph nodes, was associated with significantly reduced Medicare costs ($5613 AUD per patient for Hf-PMRT vs $8272 AUD per patient for Cf-PMRT; P < 0.001). Savings associated with Hf-PMRT ranged from $1353 (22.1%) for patients receiving no regional irradiation to $2898 (32.0%) for patients receiving both axillary and supraclavicular therapy.Conclusions: Hf-PMRT results in a significant reduction in the financial costs associated with treating breast cancer patients in a regional Australian setting when compared with Cf-PMRT. SN - 1754-9477 AD - Rural Clinical School Faculty of Medicine, University of New South Wales AD - Department of Radiation Oncology, North Coast Cancer Institute AD - Epidemiology, Executive Medical Services, Western Sydney Local Health District U2 - PMID: 26511607. DO - 10.1111/1754-9485.12405 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=112506105&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 112162494 T1 - Racial Variation in the Uptake of Oncotype DX Testing for Early-Stage Breast Cancer. AU - Roberts, Megan C. AU - Weinberger, Morris AU - Dusetzina, Stacie B. AU - Dinan, Michaela A. AU - Reeder-Hayes, Katherine E. AU - Carey, Lisa A. AU - Troester, Melissa A. AU - Wheeler, Stephanie B. Y1 - 2016/01/10/ N1 - Accession Number: 112162494. Language: English. Entry Date: 20160507. Revision Date: 20170126. Publication Type: journal article; research. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Instrumentation: Ferrans and Powers Quality of Life Index. Grant Information: P50-CA58223/CA/NCI NIH HHS/United States. NLM UID: 8309333. KW - Drug Therapy -- Statistics and Numerical Data KW - Healthcare Disparities KW - Blacks -- Statistics and Numerical Data KW - Gene Expression Profiling -- Statistics and Numerical Data KW - Breast Neoplasms -- Pathology KW - Drug Therapy -- Methods KW - Breast Neoplasms -- Ethnology KW - North Carolina KW - Risk Factors KW - Gene Expression Profiling -- Economics KW - Middle Age KW - Poisson Distribution KW - Healthcare Disparities -- Statistics and Numerical Data KW - Epidermal Growth Factors -- Analysis KW - Breast Neoplasms KW - Neoplasm Staging KW - Practice Guidelines KW - Risk Assessment KW - Predictive Value of Tests KW - Insurance Coverage KW - Female KW - Aged KW - Neoplasm Metastasis KW - Study Design KW - Adult KW - Clinical Trials KW - Confounding Variable KW - Ferrans and Powers Quality of Life Index SP - 130 EP - 138 JO - Journal of Clinical Oncology JF - Journal of Clinical Oncology JA - J CLIN ONCOL VL - 34 IS - 2 CY - Alexandria, Virginia PB - American Society of Clinical Oncology AB - Purpose: Oncotype DX (ODX) is a tumor gene-profiling test that aids in adjuvant chemotherapy decision-making. ODX has the potential to improve quality of care; however, if not equally accessible across racial groups, disparities in cancer care quality may persist or worsen. We examined racial disparities in ODX testing uptake.Methods: We used data from the Carolina Breast Cancer Study, phase III, a longitudinal, population-based study of 2,998 North Carolina women who received a diagnosis of breast cancer between 2008 and 2014. Our primary analysis used modified Poisson regression to determine the association between race and whether ODX testing was ordered among two strata: node-negative and node-positive breast cancer.Results: A total of 1,468 women with estrogen receptor-positive, human epidermal growth factor receptor-2-negative, stage I or II breast cancer met inclusion criteria. Black patients had higher-grade and larger tumors, more comorbidities, younger age at diagnosis, and lower socioeconomic status than non-black women. Overall, 42% of women had ODX test results in their pathology reports. Compared with those who did not receive ODX testing, women who received ODX testing tended to be younger and have medium tumor size and grade. Our regression analyses indicated no racial disparities in ODX uptake among node-negative patients. However, racial differences were detected among node-positive patients, with black patients being 46% less likely to receive ODX testing than non-black women (adjusted relative risk, 0.54; 95% CI, 0.35 to 0.84; P = .006).Conclusion: We did not find racial disparities in ODX testing for node-negative patients for whom ODX testing is guideline recommended and widely covered by insurers. However, our findings suggest that a newer, non-guideline-concordant application of ODX testing for node-positive breast cancer was accessed less by black women than by non-black women, reflecting more guideline concordant care among black women. SN - 0732-183X AD - University of North Carolina at Chapel Hill, Chapel Hill AD - Durham Veterans Affairs Medical Center for Health Services Research AD - Duke Clinical Research Institute and Duke Cancer Institute, Durham, NC U2 - PMID: 26598755. DO - 10.1200/JCO.2015.63.2489 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=112162494&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 112197045 T1 - Exploring Decision-Making about Neo-adjuvant Chemotherapy for Breast Cancer. AU - Zdenkowski, Nicholas AU - Butow, Phyllis AU - Fewster, Sheryl AU - Beckmore, Corinna AU - Wells, Kathryn AU - Forbes, John F. AU - Boyle, Frances Y1 - 2016/01//Jan/Feb2016 N1 - Accession Number: 112197045. Language: English. Entry Date: 20160113. Revision Date: 20170203. Publication Type: Article; letter; research. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Peer Reviewed; USA. NLM UID: 9505539. KW - Chemotherapy, Adjuvant -- Utilization KW - Neoadjuvant Therapy -- Utilization KW - Decision Making, Patient KW - Breast Neoplasms -- Therapy KW - Human KW - Female KW - Semi-Structured Interview KW - Qualitative Studies KW - Descriptive Statistics KW - Patient Attitudes KW - Quality of Life KW - Physician-Patient Relations KW - Trust KW - Thematic Analysis KW - Communication KW - Support, Psychosocial KW - Cancer Patients -- Psychosocial Factors -- Australia KW - Australia SP - 133 EP - 134 JO - Breast Journal JF - Breast Journal JA - BREAST J VL - 22 IS - 1 CY - Malden, Massachusetts PB - Wiley-Blackwell AB - The article discusses aspects of decision making in neo-adjuvant chemotherapy (NACT) for breast cancer. Topics include women's trust in clinicians to avoid the burden of decision-making in NACT for the treatment of breast cancer, women's access to a decision-support tool to help in their decision-making and the reasons behind breast cancer patients consideration of NACT. SN - 1075-122X AD - Australia and New Zealand Breast Cancer, Trials Group, Newcastle, New South Wales, Australia AD - Breast Cancer Network Australia, Camberwell, Victoria, Australia DO - 10.1111/tbj.12537 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=112197045&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 112337504 T1 - A validation of the Oswestry Spinal Risk Index. AU - Whitehouse, S. AU - Stephenson, J. AU - Sinclair, V. AU - Gregory, J. AU - Tambe, A. AU - Verma, R. AU - Siddique, Irfan AU - Saeed, Mohammad Y1 - 2016/01// N1 - Accession Number: 112337504. Language: English. Entry Date: 20160903. Revision Date: 20171020. Publication Type: journal article; research. Journal Subset: Biomedical; Continental Europe; Europe; Peer Reviewed. Instrumentation: Karnofsky Performance Status Scale (KPS). NLM UID: 9301980. KW - Lung Neoplasms -- Pathology KW - Decision Support Techniques KW - Spinal Cord Compression -- Etiology KW - Spinal Neoplasms -- Mortality KW - Breast Neoplasms -- Pathology KW - Spinal Neoplasms KW - Adult KW - Human KW - Retrospective Design KW - Middle Age KW - Aged KW - Spinal Neoplasms -- Surgery KW - Prognosis KW - Male KW - Aged, 80 and Over KW - Risk Assessment KW - Female KW - Spinal Cord Compression -- Surgery KW - Spinal Neoplasms -- Complications KW - Validation Studies KW - Comparative Studies KW - Evaluation Research KW - Multicenter Studies KW - Karnofsky Performance Status SP - 247 EP - 251 JO - European Spine Journal JF - European Spine Journal JA - EUR SPINE J VL - 25 IS - 1 CY - , PB - Springer Science & Business Media B.V. AB - Purpose: The purpose of this study was to validate the Oswestry Spinal Risk Index (OSRI) in an external population. The OSRI predicts survival in patients with metastatic spinal cord compression (MSCC).Methods: We analysed the data of 100 patients undergoing surgical intervention for MSCC at a tertiary spinal unit and recorded the primary tumour pathology and Karnofsky performance status to calculate the OSRI. Logistic regression models and survival plots were applied to the data in accordance with the original paper.Results: Lower OSRI scores predicted longer survival. The OSRI score predicted survival accurately in 74% of cases (p = 0.004).Conclusions: Our study has found that the OSRI is a significant predictor of survival at levels similar to those of the original authors and is a useful and simple tool in aiding complex decision making in patients presenting with MSCC. SN - 0940-6719 AD - ST7 Orthopaedics, North West Deanery, Manchester UK AD - School of Human and Health Sciences, University of Huddersfield, Huddersfield UK AD - University of Manchester, Manchester UK AD - Salford Royal Foundation Trust, Salford UK U2 - PMID: 25391625. DO - 10.1007/s00586-014-3665-4 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=112337504&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 112337546 T1 - The Oswestry Spinal Risk Index (OSRI): an external validation study. AU - Fleming, Christina AU - Baker, Joseph AU - O'Neill, Shane AU - Rowan, Fiachra AU - Byrne, Damien AU - Synnott, Keith AU - Baker, Joseph F AU - O'Neill, Shane C AU - Rowan, Fiachra E AU - Byrne, Damien P Y1 - 2016/01// N1 - Accession Number: 112337546. Language: English. Entry Date: 20160903. Revision Date: 20171020. Publication Type: journal article; research. Journal Subset: Biomedical; Continental Europe; Europe; Peer Reviewed. Instrumentation: General Health Questionnaire (GHQ); Karnofsky Performance Status Scale (KPS). NLM UID: 9301980. KW - Spinal Neoplasms KW - Adenocarcinoma -- Mortality KW - Adenocarcinoma KW - Spinal Neoplasms -- Mortality KW - Prostatic Neoplasms -- Pathology KW - Decision Support Techniques KW - Breast Neoplasms -- Pathology KW - Human KW - Adult KW - Karnofsky Performance Status KW - Middle Age KW - Aged, 80 and Over KW - Prognosis KW - Risk Assessment KW - Male KW - Aged KW - Survival KW - Resource Databases KW - Female KW - Validation Studies KW - Comparative Studies KW - Evaluation Research KW - Multicenter Studies KW - Questionnaires SP - 252 EP - 256 JO - European Spine Journal JF - European Spine Journal JA - EUR SPINE J VL - 25 IS - 1 CY - , PB - Springer Science & Business Media B.V. AB - Purpose: The Oswestry Spinal Risk Index (OSRI) was recently reported as an adjunct in the management of metastatic spinal disease. Based on the tumour type and a general condition score, survivorship is predicted. We aimed to externally validate this new score.Methods: We assessed the survivorship of 121 patients identified from a prospectively collated database in the National Spinal Injuries Unit in the Republic of Ireland. Actual survivorship was calculated according to the tumour subtype and general conditioning, according to the Karnofsky Performance Score (OSRI = Primary Tumour Pathology + (2-General Conditioning Score)). Our results were then compared to those previously published.Results: 45.5 % were female (n = 55). The mean age at presentation was 61.5 years (range 23-85). Breast and prostate cancers were the most frequent diseases encountered. The actual survival in our cohort closely mirrored the predicted survival, according to the equation used to calculate the OSRI with an overall strong correlation found (r = 0.798, p = 0.001).Conclusion: We found that the OSRI is a simple to use scoring system. We found a strong correlation in our results with the predicted survivorship based on the OSRI. The OSRI can be used as a useful adjunct in the management of patient with metastatic disease of the spine. SN - 0940-6719 AD - Department of Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin Ireland AD - Department of Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland AD - Department of Orthopaedic Surgery, Galway University Hospital, Galway, Ireland U2 - PMID: 25539764. DO - 10.1007/s00586-014-3730-z UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=112337546&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 116925416 T1 - Applying Data Mining Techniques to Extract Hidden Patterns about Breast Cancer Survival in an Iranian Cohort Study. AU - Khalkhali, Hamid Reza AU - Afshar, Hadi Lotfnezhad AU - Esnaashari, Omid AU - Jabbari, Nasrollah Y1 - 2016///Winter2016 N1 - Accession Number: 116925416. Language: English. Entry Date: 20170712. Revision Date: 20170712. Publication Type: Article; algorithm; equations & formulas; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Middle East; Peer Reviewed; Public Health. NLM UID: 101235886. KW - Data Mining KW - Breast Neoplasms -- Iran KW - Decision Trees KW - Survival Analysis KW - Validity KW - Prospective Studies KW - Iran KW - Inpatients KW - Human SP - 31 EP - 35 JO - Journal of Research in Health Sciences JF - Journal of Research in Health Sciences JA - J RES HEALTH SCI VL - 16 IS - 1 PB - Hamadan University of Medical Sciences, School of Public Health AB - The article discusses a cohort study of the hidden patterns and rules about breast cancer survival in Iran with the application of data mining techniques. SN - 2228-7795 AD - Inpatient's Safety Research Center, Department of Biostatistics, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran AD - Department of Health Information Technology, School of Paramedicine, Urmia University of Medical Sciences, Urmia, Iran AD - Omid Treatment and Research Center, Urmia, Iran AD - Solid Tumor Research Center, Department of Medical Physics and Imaging, School of Paramedicine, Urmia University of Medical Sciences, Urmia, Iran UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=116925416&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - GEN ID - 111929551 T1 - Patient risk factors versus physician guidelines for anti-emetics. AU - Balakrishnan, Vijay Shankar Y1 - 2016/01// N1 - Accession Number: 111929551. Language: English. Entry Date: 20160519. Revision Date: 20160702. Publication Type: commentary. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. NLM UID: 100957246. KW - Antineoplastic Agents, Combined -- Adverse Effects KW - Decision Support Techniques KW - Breast Neoplasms -- Drug Therapy KW - Vomiting -- Prevention and Control KW - Antiemetics -- Administration and Dosage KW - Nausea -- Prevention and Control KW - Female SP - e7 EP - e7 JO - Lancet Oncology JF - Lancet Oncology JA - LANCET ONCOL VL - 17 IS - 1 CY - New York, New York PB - Elsevier B.V. SN - 1470-2045 U2 - PMID: 26776103. DO - 10.1016/S1470-2045(15)00536-7 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=111929551&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 118844657 T1 - EFFECT OF A WEB-BASED, DECISION SUPPORT INTERVENTION TO IMPROVE WORK ABILITY IN BREAST CANCER SURVIVORS. AU - Sesto, M. E. AU - Buhr, K. A. AU - Sun, W. AU - Chen, K. AU - Tevaarwerk, A. J. AU - Wiegmann, D. A. AU - Heidrich, S. M. Y1 - 2016/01// N1 - Accession Number: 118844657. Language: English. Entry Date: In Process. Revision Date: 20161207. Publication Type: Article. Journal Subset: Allied Health; Editorial Board Reviewed; Peer Reviewed; USA. SP - E4 EP - E4 JO - Rehabilitation Oncology JF - Rehabilitation Oncology JA - REHABIL ONCOL VL - 34 IS - 1 CY - Alexandria, Virginia PB - American Physical Therapy Association, Oncology Section SN - 2168-3808 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=118844657&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 111361366 T1 - Is febrile neutropenia prophylaxis with granulocyte-colony stimulating factors economically justified for adjuvant TC chemotherapy in breast cancer? AU - Skedgel, Chris AU - Rayson, Daniel AU - Younis, Tallal Y1 - 2016/01// N1 - Accession Number: 111361366. Language: English. Entry Date: 20160803. Revision Date: 20171128. Publication Type: journal article; research. Journal Subset: Biomedical; Continental Europe; Double Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed. Instrumentation: Clinical Decision Making in Nursing Scale (CDMNS) (Jenkins); Longitudinal Interval Follow-Up Evaluation (LIFE); Short Portable Mental Status Questionnaire (SPMSQ) (Pfeiffer); Ferrans and Powers Quality of Life Index. NLM UID: 9302957. KW - Chemotherapy, Adjuvant -- Adverse Effects KW - Breast Neoplasms -- Economics KW - Granulocyte Colony-Stimulating Factor -- Economics KW - Granulocyte Colony-Stimulating Factor -- Therapeutic Use KW - Antineoplastic Agents, Combined -- Adverse Effects KW - Breast Neoplasms -- Drug Therapy KW - Risk Factors KW - Cyclophosphamide -- Administration and Dosage KW - Hydrocarbons -- Economics KW - Quality-Adjusted Life Years KW - Cost Benefit Analysis KW - Female KW - Antineoplastic Agents, Combined -- Economics KW - Hydrocarbons -- Administration and Dosage KW - Hydrocarbons -- Adverse Effects KW - Preventive Health Care KW - Middle Age KW - Decision Support Techniques KW - Cyclophosphamide -- Adverse Effects KW - Cyclophosphamide -- Economics KW - Ferrans and Powers Quality of Life Index KW - Scales KW - Short Portable Mental Status Questionnaire SP - 387 EP - 394 JO - Supportive Care in Cancer JF - Supportive Care in Cancer JA - SUPPORT CARE CANCER VL - 24 IS - 1 CY - , PB - Springer Science & Business Media B.V. AB - Purpose: Febrile neutropenia (FN) during adjuvant chemotherapy is associated with morbidity, mortality risk, and substantial cost, and subsequent chemotherapy dose reductions may result in poorer outcomes. Patients at high risk of, or who develop FN, often receive prophylaxis with granulocyte colony-stimulating factors (G-CSF). We investigated whether different prophylaxis strategies with G-CSF offered favorable value-for-money.Methods: We developed a decision model to estimate the short- and long-term costs and outcomes of a hypothetical cohort of women with breast cancer receiving adjuvant taxotere + cyclophosphamide (TC) chemotherapy. The short-term phase estimated upfront costs and FN risks with adjuvant TC chemotherapy without G-CSF prophylaxis (i.e., chemotherapy dose reductions) as well as with secondary and primary G-CSF prophylaxis strategies. The long-term phase estimated the expected costs and quality-adjusted life years (QALYs) for patients who completed adjuvant TC chemotherapy with or without one or more episodes of FN.Results: Secondary G-CSF was associated with lower costs and greater QALY gains than a no G-CSF strategy. Primary G-CSF appears likely to be cost-effective relative to secondary G-CSF at FN rates greater than 28%, assuming some loss of chemotherapy efficacy at lower dose intensities. The cost-effectiveness of primary vs. secondary G-CSF was sensitive to FN risk and mortality, and loss of chemotherapy efficacy following FN.Conclusions: Secondary G-CSF is more effective and less costly than a no G-CSF strategy. Primary G-CSF may be justified at higher willingness-to-pay thresholds and/or higher FN risks, but this threshold FN risk appears to be higher than the 20% rate recommended by current clinical guidelines. SN - 0941-4355 AD - Norwich Medical School, University of East Anglia, Bob Champion Building Norwich NR4 7UQ UK U2 - PMID: 26081595. DO - 10.1007/s00520-015-2805-7 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=111361366&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 112339298 T1 - Expected survival with and without second-line palliative chemotherapy: who wants to know? AU - Oostendorp, Linda J.M. AU - Ottevanger, Petronella B. AU - Wouw, Agnes J. AU - Schoenaker, Ivonne J.H. AU - Graaf, Hiltje AU - Graaf, Winette T.A. AU - Stalmeier, Peep F.M. Y1 - 2015/12// N1 - Accession Number: 112339298. Language: English. Entry Date: 20160201. Revision Date: 20171010. Publication Type: Article; research; tables/charts. Journal Subset: Europe; Health Services Administration; Peer Reviewed; UK & Ireland. Grant Information: This work was supported by the Dutch CancerSociety, Amsterdam, the Netherlands (grantnumber KUN 2006-3465).. NLM UID: 9815926. KW - Survival Analysis KW - Palliative Care KW - Chemotherapy, Cancer -- Adverse Effects KW - Access to Information KW - Patient Rights KW - Human KW - Health Services Accessibility -- Evaluation KW - Communication KW - Randomized Controlled Trials KW - Netherlands KW - Socioeconomic Factors KW - Demography KW - Data Analysis KW - Colorectal Neoplasms -- Diagnosis KW - Breast Neoplasms -- Diagnosis KW - Funding Source SP - 2903 EP - 2914 JO - Health Expectations JF - Health Expectations JA - HEALTH EXPECTATIONS VL - 18 IS - 6 CY - Malden, Massachusetts PB - Wiley-Blackwell AB - The article presents a study regarding information preferences by offering patients a decision aid (DA) concerning expected survival for treatment options such as supportive care with or without second-line palliative chemotherapy. Information on clinical and psychosocial characteristics of patients were collected. Details on the predictors of accepting survival information were also presented. SN - 1369-6513 AD - Department for Health Evidence, Radboud University Medical Centre AD - Department of Medical Oncology Radboud University Medical Centre AD - Department of Internal Medicine, VieCuri Medical Centre AD - Department of Internal Medicine, Isala Clinics AD - Leeuwarden Oncology Centre, Medical Centre Leeuwarden AD - Department of Medical Oncology, Radboud University Medical Centre DO - 10.1111/hex.12275 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=112339298&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - ID - 110890262 T1 - Informed Decision-Making and Breast Cancer Screening. AU - Sasieni, P. D. AU - Smith, R. A. AU - Duffy, S. W. Y1 - 2015/12// N1 - Accession Number: 110890262. Language: English. Entry Date: 20170616. Revision Date: 20170616. Publication Type: Editorial; commentary; editorial. Journal Subset: Biomedical; Editorial Board Reviewed; Europe; Peer Reviewed; UK & Ireland. NLM UID: 9433359. KW - Breast Neoplasms KW - Cancer Screening KW - Decision Making KW - Health Knowledge SP - 165 EP - 167 JO - Journal of Medical Screening JF - Journal of Medical Screening JA - J MED SCREEN VL - 22 IS - 4 PB - Sage Publications, Ltd. AB - The article reflects on the study regarding influences of the alternative-content decision aids on the attitudes, intentions, and knowledge related to the screening of breast cancer. Topics include the various fundamental principles included in the study, the several aspects related to the validity of the information regarding the provision of intervention, and the transparency of the claimed diagnosed cases included in the study. SN - 0969-1413 AD - Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK AD - Cancer Screening, American Cancer Society, Atlanta, GA, USA U2 - PMID: 26018778. DO - 10.1177/0969141315587344 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=110890262&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 115107150 T1 - RECONSTRUCCIÓN INMEDIATA EN CÁNCER DE MAMA. ¿LAS MUJERES ESTÁN SATISFECHAS CON SU DECISIÓN? AU - de la Flor López, Miriam AU - De Molina Fernández, Inmaculada AU - Sirgo Rodríguez, Agustina AU - Montes Muñoz, Maria Jesús Y1 - 2015/12// N1 - Accession Number: 115107150. Language: Spanish. Entry Date: 20160513. Revision Date: 20160513. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Continental Europe; Europe. Special Interest: Women's Health. KW - Breast Neoplasms -- Surgery KW - Mastectomy KW - Breast Reconstruction KW - Patient Satisfaction KW - Breast Neoplasms -- Psychosocial Factors KW - Human KW - Female KW - Qualitative Studies KW - Interviews KW - Focus Groups KW - Audiorecording SP - 393 EP - 403 JO - Psicooncologia JF - Psicooncologia JA - PSICOONCOLOGIA VL - 12 IS - 2/3 PB - Asociacion de Psicooncologia de Madrid AB - Objective: To know the experiences, expectations and perceived satisfaction in a group of breast cancer women who had undergone immediate breast reconstruction after mastectomy. Material and Methods: 20 women took part in a qualitative study. 4 women were assessed through an in-depth interview and the other 16 women were divided into two focus groups (8 each). The recorded interview and focus group discussions were transcribed and analyzed using "framework analysis". Results: Five areas were explored: 1) Impact of cancer diagnosis, 2) Information received about the surgery, 3) Post-surgery experiences, 4) Fulfilment of expectations and 5) Satisfaction with the decision. Cancer diagnosis was overwhelming for most of the women. For women, information received was considered good and sufficient, but the study shows that after the post-surgical period, more complaints related to pain and other complications appear. The expectations about immediate breast reconstruction were linked with the final aesthetic results. Some women would choose to do the same procedure again despite the complications but some other women would not choose the same option because of the complications and they regret their decision. Conclusion: There is no clear and unanimous position among women about whether they would go through immediate breast reconstruction again and whether the surgery has fulfilled their expectations. The patients need complete, unbiased and appropriate information in order to be able to make an informed and shared decision. It is for that reason that we think it is necessary to devise patient decision aids which could facilitate the information delivering process to patients. AB - Objetivo: Conocer las vivencias, expectativas y satisfacción percibida de un grupo de mujeres diagnosticadas de cáncer de mama con mastectomía con reconstrucción en el mismo acto quirúrgico. Material y Métodos: La metodología utilizada en esta investigación ha sido la cualitativa y las técnicas para la recogida de la información fueron la entrevista en profundidad (cuatro mujeres) y el grupo focal (dos grupos de 8 pacientes cada uno). Resultados: se exploraron cinco áreas 1) El impacto del diagnóstico del cáncer 2) Información recibida ante la intervención 3) Las experiencias en el postoperatorio. 4) Cumplimiento de expectativas y 5) Satisfacción con la decisión tomada. El diagnóstico fue impactante para la mayoría de las mujeres. Inicialmente, la información recibida se consideró buena y suficiente pero hemos comprobado que posteriormente, una vez superada la convalecencia de la intervención, aparecen más quejas sobre todo relacionadas con las complicaciones posteriores y con el dolor. Las expectativas sobre la reconstrucción inmediata estuvieron muy ligadas con los resultados estéticos finales. Algunas mujeres volverían a pasar por lo mismo a pesar de las complicaciones y otras dan mucho valor a los inconvenientes y no se lo volverían a hacer. Conclusiones: No aparece una postura clara y unánime entre las pacientes de si se volverían a reconstruir y si se han cumplido sus expectativas. La paciente necesita una información real, ecuánime y adaptada para poder tomar una decisión compartida. Por eso, creemos necesario elaborar herramientas de toma de decisiones compartidas que faciliten que la información llegue a la paciente. SN - 1696-7240 AD - Servicio de Ginecología y Obstetricia. H.U. de Tarragona Joan XXII. Departamento de Medicina y Cirugía Universidad Rovira i Virgili. Instituto Investigaciones Sanitarias Pere Virgili. Tarragona. España AD - Departamento de Enfermería. Universidad Rovira i Virgili. Tarragona. España AD - Unidad de Psicooncologia, Instituto de Oncología de la Catalunya Sud. Servicio de Oncología. H.U. Sant Joan de Reus. Departamento de Medicina y Cirugía, Universidad Rovira i Virgili. Instituto Investigaciones Sanitarias Pere Virgili. Reus. España DO - 10.5209/rev_PSIC.2015.v12.n2-3.51017 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=115107150&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 110870116 T1 - Impact of a decision aid on reducing uncertainty: pilot study of women in their 40s and screening mammography. AU - Scariati, Paula AU - Nelson, Lisa AU - Watson, Lindsey AU - Bedrick, Stephen AU - Eden, Karen B. Y1 - 2015/11/10/ N1 - Accession Number: 110870116. Language: English. Entry Date: In Process. Revision Date: 20170929. Publication Type: journal article; research. Journal Subset: Biomedical; Computer/Information Science; Europe; UK & Ireland. Instrumentation: Impact of Events Scale (IES); Clinical Decision Making in Nursing Scale (CDMNS) (Jenkins). Grant Information: T15 LM007088/LM/NLM NIH HHS/United States. NLM UID: 101088682. KW - Breast Neoplasms -- Diagnosis KW - Patient Satisfaction KW - Uncertainty KW - Decision Support Techniques KW - Mammography KW - Female KW - Pilot Studies KW - Middle Age KW - Adult KW - Breast Neoplasms -- Prevention and Control KW - Impact of Events Scale KW - Scales SP - 1 EP - 8 JO - BMC Medical Informatics & Decision Making JF - BMC Medical Informatics & Decision Making JA - BMC MED INFORM DECIS MAKING VL - 15 PB - BioMed Central AB - Background: In 2009 the United States Preventive Services Task Force updated its breast cancer screening guidelines to recommend that average-risk women obtain a screening mammogram every two years starting at age 50 instead of annually starting at age 40. Inconsistencies in data regarding the benefit versus risk of routine screening for women less than 50-years-of-age led to a second recommendation - that women in their forties engage in a shared decision making process with their provider to make an individualized choice about screening mammography that was right for them. In response, a web-based interactive mammography screening decision aid was developed and evaluated.Methods: The decision aid was developed using an agile, iterative process. It was further honed based on feedback from clinical and technical subject matter experts. A convenience sample of 51 age- and risk-appropriate women was recruited to pilot the aid. Pre-post decisional conflict and screening choice was assessed.Results: Women reported a significant reduction in overall decisional conflict after using the decision aid (Z = -5.3, p < 0.001). These participants also reported statistically significant reductions in each of the decisional conflict subscales: feeling uncertain (Z = -4.7, p < 0.001), feeling uninformed (Z = -5.2, p < 0.001), feeling unclear about values (Z = -5.0, p < 0.001), and feeling unsupported (Z = -4.0, p < 0.001). However, a woman's intention to obtain a screening mammogram in the next 1-2 years was not significantly changed (Wilcoxon signed-rank Z = -1.508, p = 0.132).Conclusion: This mammography screening decision aid brings value to patient care not by impacting what a woman chooses but by lending clarity to why or how she chooses it. SN - 1472-6947 AD - Marin General Hospital, Greenbrae, CA, USA AD - ConvergeHEALTH by Deloitte, Newton, MA, USA AD - Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA AD - Center for Spoken Language and Understanding, Oregon Health & Science University, Portland, OR, USA AD - Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, OR, USA U2 - PMID: 26554555. DO - 10.1186/s12911-015-0210-2 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=110870116&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 110026106 T1 - Adjuvant therapeutic decisions in elderly breast cancer patients: the role of chemotherapy in a retrospective analysis. AU - Jueckstock, J. AU - Kasch, F. AU - Jaeger, B. AU - Schramm, A. AU - Janni, W. AU - Scholz, C. Y1 - 2015/11// N1 - Accession Number: 110026106. Language: English. Entry Date: 20160129. Revision Date: 20161031. Publication Type: journal article. Journal Subset: Biomedical; Continental Europe; Europe. Instrumentation: Longitudinal Interval Follow-Up Evaluation (LIFE); Functional Living Index: Cancer (FLIC) (Schipper et al). NLM UID: 8710213. KW - Breast Neoplasms -- Therapy KW - Mastectomy KW - Radiotherapy, Adjuvant -- Methods KW - Chemotherapy, Adjuvant -- Methods KW - Lymph Nodes -- Pathology KW - Combined Modality Therapy KW - Retrospective Design KW - Breast Neoplasms -- Mortality KW - Survival KW - Adult KW - Aged KW - Neoplasm Staging KW - Aged, 80 and Over KW - Female KW - Breast Neoplasms -- Pathology KW - Treatment Outcomes KW - Clinical Assessment Tools SP - 1101 EP - 1107 JO - Archives of Gynecology & Obstetrics JF - Archives of Gynecology & Obstetrics JA - ARCH GYNECOL OBSTET VL - 292 IS - 5 CY - , PB - Springer Science & Business Media B.V. AB - Purpose: Decisions on the type of adjuvant treatment in older breast cancer patients are challenging. Side effects of chemotherapy have to be weighed against life expectancy, comorbidities, functional status, and frailty on the basis of studies usually excluding patients over 69 years. To aid this decision, we analyzed a database of 6000 unselected patients and of those evaluated elderly primary breast cancer patients with hormone receptor-negative tumors from 1963 until 2003 in respect of survival data depending on adjuvant treatment.Methods: A total of 131 elderly (i.e., >65 years) patients were observed retrospectively for a median of 72 months. Patients received breast-conserving therapy or mastectomy and adjuvant radiotherapy, chemotherapy, and endocrine therapy. Data were collected from a hospital-intern database.Results: Median age at diagnosis was 72 years. Mostly, tumors were small (81 % T1, 17 % T2) but of unfavorable grading (40 % G2, 35 % G3). Lymph nodes were positive in 42 %. Mastectomy was performed in 65 %. While 42 % of patients received radiotherapy, only 10 % were treated with chemotherapy. Patients with G2 and G3 tumors (p = 0.027), younger women (p = 0.012), and patients with positive lymph node status (p < 0.0001) more likely received chemotherapy. Recurrence-free survival was longer in patients without chemotherapy (37 vs. 29 months, p = 0.234). Overall survival was non-significantly shorter in patients who received chemotherapy (59 vs. 81 months, p = 0.131).Conclusions: In this analysis, adjuvant chemotherapy was not associated with improved survival, presumably caused by an a priori poor prognosis of these patients. For an aging society more data are urgently needed to help selecting and personalizing adjuvant treatment within subgroups of breast cancer in older women. SN - 0932-0067 AD - Department of Gynecology and Obstetrics, Ludwig-Maximilians-University Munich, Campus Innenstadt, Maistr. 11 80337 Munich Germany AD - Department of Cardiology, Klinikum Hamburg-Harburg, Hamburg Germany AD - Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm Germany U2 - PMID: 25935195. DO - 10.1007/s00404-015-3728-8 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=110026106&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 110941488 T1 - A hybrid cost-sensitive ensemble for imbalanced breast thermogram classification. AU - Krawczyk, Bartosz AU - Schaefer, Gerald AU - Woźniak, Michał Y1 - 2015/11// N1 - Accession Number: 110941488. Language: English. Entry Date: 20160831. Revision Date: 20160831. Publication Type: journal article. Journal Subset: Biomedical; Blind Peer Reviewed; Computer/Information Science; Continental Europe; Europe; Expert Peer Reviewed; Peer Reviewed. NLM UID: 8915031. KW - Breast Neoplasms -- Diagnosis KW - Thermography -- Economics KW - Thermography -- Methods KW - Decision Trees KW - Diagnosis, Computer Assisted -- Methods KW - False Positive Results KW - Female KW - Cost Benefit Analysis KW - False Negative Results KW - Algorithms KW - Sensitivity and Specificity SP - 219 EP - 227 JO - Artificial Intelligence in Medicine JF - Artificial Intelligence in Medicine JA - ARTIF INTELL MED VL - 65 IS - 3 PB - Elsevier B.V. AB - Objectives: Early recognition of breast cancer, the most commonly diagnosed form of cancer in women, is of crucial importance, given that it leads to significantly improved chances of survival. Medical thermography, which uses an infrared camera for thermal imaging, has been demonstrated as a particularly useful technique for early diagnosis, because it detects smaller tumors than the standard modality of mammography.Methods and Material: In this paper, we analyse breast thermograms by extracting features describing bilateral symmetries between the two breast areas, and present a classification system for decision making. Clearly, the costs associated with missing a cancer case are much higher than those for mislabelling a benign case. At the same time, datasets contain significantly fewer malignant cases than benign ones. Standard classification approaches fail to consider either of these aspects. In this paper, we introduce a hybrid cost-sensitive classifier ensemble to address this challenging problem. Our approach entails a pool of cost-sensitive decision trees which assign a higher misclassification cost to the malignant class, thereby boosting its recognition rate. A genetic algorithm is employed for simultaneous feature selection and classifier fusion. As an optimisation criterion, we use a combination of misclassification cost and diversity to achieve both a high sensitivity and a heterogeneous ensemble. Furthermore, we prune our ensemble by discarding classifiers that contribute minimally to the decision making.Results: For a challenging dataset of about 150 thermograms, our approach achieves an excellent sensitivity of 83.10%, while maintaining a high specificity of 89.44%. This not only signifies improved recognition of malignant cases, it also statistically outperforms other state-of-the-art algorithms designed for imbalanced classification, and hence provides an effective approach for analysing breast thermograms.Conclusions: Our proposed hybrid cost-sensitive ensemble can facilitate a highly accurate early diagnostic of breast cancer based on thermogram features. It overcomes the difficulties posed by the imbalanced distribution of patients in the two analysed groups. SN - 0933-3657 AD - Department of Systems and Computer Networks, Wrocław University of Technology, Wyb. Wyspianskiego 27, 50-370 Wrocław, Poland AD - Department of Computer Science, Loughborough University, Loughborough LE11 3TU, UK U2 - PMID: 26319694. DO - 10.1016/j.artmed.2015.07.005 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=110941488&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 110433254 T1 - Informed shared decision-making supported by decision coaches for women with ductal carcinoma in situ: study protocol for a cluster randomized controlled trial. AU - Berger-Höger, Birte AU - Liethmann, Katrin AU - Mühlhauser, Ingrid AU - Haastert, Burkhard AU - Steckelberg, Anke Y1 - 2015/10/12/ N1 - Accession Number: 110433254. Language: English. Entry Date: In Process. Revision Date: 20160720. Publication Type: journal article. Journal Subset: Biomedical; Europe; UK & Ireland. Special Interest: Evidence-Based Practice. Instrumentation: Arthritis Impact Measurement Scale (AIMS) (Meenan). NLM UID: 101263253. KW - Consumer Participation KW - Adenocarcinoma -- Therapy KW - Communication KW - Breast Neoplasms -- Therapy KW - Physician-Patient Relations KW - Decision Making KW - Nurse-Patient Relations KW - Attitude of Health Personnel KW - Decision Support Techniques KW - Adenocarcinoma -- Psychosocial Factors KW - Human KW - Study Design KW - Consent KW - Patient Education KW - Breast Neoplasms -- Psychosocial Factors KW - Adenocarcinoma -- Diagnosis KW - Breast Neoplasms -- Diagnosis KW - Female KW - Attitude to Health KW - Breast Neoplasms -- Nursing KW - Germany KW - Validation Studies KW - Comparative Studies KW - Evaluation Research KW - Multicenter Studies KW - Randomized Controlled Trials KW - Arthritis Impact Measurement Scales SP - 1 EP - 16 JO - Trials JF - Trials JA - TRIALS VL - 16 IS - 1 PB - BioMed Central AB - Background: Women with breast cancer want to participate in treatment decision-making. Guidelines have confirmed the right of informed shared decision-making. However, previous research has shown that the implementation of informed shared decision-making is suboptimal for reasons of limited resources of physicians, power imbalances between patients and physicians and missing evidence-based patient information. We developed an informed shared decision-making program for women with primary ductal carcinoma in situ (DCIS). The program provides decision coaching for women by specialized nurses and aims at supporting involvement in decision-making and informed choices. In this trial, the informed shared decision-making program will be evaluated in breast care centers.Methods/design: A cluster randomized controlled trial will be conducted to compare the informed shared decision-making program with standard care. The program comprises an evidence-based patient decision aid and training of physicians (2 hours) and specialized breast care and oncology nurses (4 days) in informed shared decision-making. Sixteen certified breast care centers will be included, with 192 women with primary DCIS being recruited. Primary outcome is the extent of patients' involvement in shared decision-making as assessed by the MAPPIN-Odyad (Multifocal approach to the 'sharing' in shared decision-making: observer instrument dyad). Secondary endpoints include the sub-measures of the MAPPIN-inventory (MAPPIN-Onurse, MAPPIN-Ophysician, MAPPIN-Opatient, MAPPIN-Qnurse, MAPPIN-Qpatient and MAPPIN-Qphysician), informed choice, decisional conflict and the duration of encounters. It is expected that decision coaching and the provision of evidence-based patient decision aids will increase patients' involvement in decision-making with informed choices and reduce decisional conflicts and duration of physician encounters. Furthermore, an accompanying process evaluation will be conducted.Discussion: To our knowledge, this is the first study investigating the implementation of decision coaches in German breast care centers.Trial Registration: Current Controlled Trials ISRCTN46305518 , date of registration: 5 June 2015. SN - 1745-6215 AD - University of Hamburg, MIN-Faculty, Unit of Health Sciences and Education, Martin-Luther-King-Platz 6, D-20146 Hamburg, Germany AD - mediStatistica Neuenrade, Lambertusweg 1b, D-58809 Neuenrade, Germany U2 - PMID: 26458964. DO - 10.1186/s13063-015-0991-8 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=110433254&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 109500529 T1 - An Analysis of the Decision-Making Process for Contralateral Prophylactic Mastectomy and Breast Reconstruction. AU - Buchanan, Patrick J. AU - Abdulghani, Mariam AU - Waljee, Jennifer F. AU - Kozlow, Jeffrey H. AU - Newman, Lisa A. AU - Chung, Kevin C. AU - Momoh, Adeyiza O. Y1 - 2015/10/02/Oct2015 Supplement 1 N1 - Accession Number: 109500529. Language: English. Entry Date: In Process. Revision Date: 20150923. Publication Type: Article. Supplement Title: Oct2015 Supplement 1. Journal Subset: Biomedical; USA. NLM UID: 9431305. SP - S18 EP - S18 JO - Journal of the American College of Surgeons JF - Journal of the American College of Surgeons JA - J AM COLL SURG VL - 221 CY - New York, New York PB - Elsevier B.V. SN - 1072-7515 AD - University of Michigan, Ann Arbor, MI DO - 10.1016/j.jamcollsurg.2015.07.029 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109500529&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 110842363 T1 - Decision Support for Women With Early Breast Cancer. AU - Donnelly-Strozzo, Mary K. AU - Belcher, Anne Y1 - 2015/10// N1 - Accession Number: 110842363. Language: English. Entry Date: In Process. Revision Date: 20170925. Publication Type: Article. Journal Subset: Nursing; Peer Reviewed; USA. SP - 222 EP - 230 JO - Clinical Scholars Review JF - Clinical Scholars Review JA - CLIN SCHOLARS REV VL - 8 IS - 2 CY - New York, New York PB - Springer Publishing Company, Inc. SN - 1939-2095 AD - Johns Hopkins University School of Nursing, Baltimore, Maryland DO - 10.1891/1939-2095.8.2.222 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=110842363&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 109563589 T1 - Breast Density and Benign Breast Disease: Risk Assessment to Identify Women at High Risk of Breast Cancer. AU - Tice, Jeffrey A. AU - Miglioretti, Diana L. AU - Chin-Shang Li AU - Vachon, Celine M. AU - Gard, Charlotte C. AU - Kerlikowske, Karla AU - Li, Chin-Shang Y1 - 2015/10//10/1/2015 N1 - Accession Number: 109563589. Language: English. Entry Date: 20151223. Revision Date: 20161206. Publication Type: journal article; research. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Grant Information: HHSN261201100031C/CA/NCI NIH HHS/United States. NLM UID: 8309333. KW - Breast -- Pathology KW - Breast Diseases -- Epidemiology KW - Cell Physiology KW - Breast Neoplasms -- Epidemiology KW - Decision Support Techniques KW - Prognosis KW - Breast Diseases -- Diagnosis KW - Mammography KW - Multivariate Analysis KW - United States KW - Aged KW - Data Collection KW - Breast Neoplasms -- Diagnosis KW - Time Factors KW - ROC Curve KW - Cox Proportional Hazards Model KW - Pharmacokinetics KW - Biopsy KW - Adult KW - Risk Assessment KW - Breast Diseases -- Mortality KW - Incidence KW - Predictive Value of Tests KW - Reproducibility of Results KW - Kaplan-Meier Estimator KW - Middle Age KW - Female KW - Breast Neoplasms -- Mortality KW - Risk Factors SP - 3137 EP - 3143 JO - Journal of Clinical Oncology JF - Journal of Clinical Oncology JA - J CLIN ONCOL VL - 33 IS - 28 CY - Alexandria, Virginia PB - American Society of Clinical Oncology AB - Purpose: Women with proliferative breast lesions are candidates for primary prevention, but few risk models incorporate benign findings to assess breast cancer risk. We incorporated benign breast disease (BBD) diagnoses into the Breast Cancer Surveillance Consortium (BCSC) risk model, the only breast cancer risk assessment tool that uses breast density.Methods: We developed and validated a competing-risk model using 2000 to 2010 SEER data for breast cancer incidence and 2010 vital statistics to adjust for the competing risk of death. We used Cox proportional hazards regression to estimate the relative hazards for age, race/ethnicity, family history of breast cancer, history of breast biopsy, BBD diagnoses, and breast density in the BCSC.Results: We included 1,135,977 women age 35 to 74 years undergoing mammography with no history of breast cancer; 17% of the women had a prior breast biopsy. During a mean follow-up of 6.9 years, 17,908 women were diagnosed with invasive breast cancer. The BCSC BBD model slightly overpredicted risk (expected-to-observed ratio, 1.04; 95% CI, 1.03 to 1.06) and had modest discriminatory accuracy (area under the receiver operator characteristic curve, 0.665). Among women with proliferative findings, adding BBD to the model increased the proportion of women with an estimated 5-year risk of 3% or higher from 9.3% to 27.8% (P<.001).Conclusion: The BCSC BBD model accurately estimates women's risk for breast cancer using breast density and BBD diagnoses. Greater numbers of high-risk women eligible for primary prevention after BBD diagnosis are identified using the BCSC BBD model. SN - 0732-183X AD - University of California, San Francisco, San Francisco AD - University of California, Davis, Davis, CA AD - Group Health Research Institute, Group Health Cooperative, Seattle, WA AD - Mayo Clinic, Rochester, MN AD - New Mexico State University, Las Cruces, NM AD - Jeffrey A. Tice and Karla Kerlikowske, University of California, San Francisco, San Francisco; Diana L. Miglioretti and Chin-Shang Li, University of California, Davis, Davis, CA; Diana L. Miglioretti, Group Health Research Institute, Group Health Cooperative, Seattle, WA; Celine M. Vachon, Mayo Clinic, Rochester, MN; and Charlotte C. Gard, New Mexico State University, Las Cruces, NM U2 - PMID: 26282663. DO - 10.1200/JCO.2015.60.8869 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109563589&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 109465612 T1 - An Efficient Approach for Automated Mass Segmentation and Classification in Mammograms. AU - Dong, Min AU - Lu, Xiangyu AU - Ma, Yide AU - Guo, Yanan AU - Ma, Yurun AU - Wang, Keju Y1 - 2015/10// N1 - Accession Number: 109465612. Language: English. Entry Date: 20151207. Revision Date: 20160930. Publication Type: Article; diagnostic images; equations & formulas; research; tables/charts. Journal Subset: Allied Health; Biomedical; Computer/Information Science; Double Blind Peer Reviewed; Peer Reviewed; USA. Special Interest: Oncologic Care. NLM UID: 9100529. KW - Mammography KW - Breast Neoplasms -- Diagnosis KW - Diagnosis, Computer Assisted KW - Radiographic Image Interpretation, Computer-Assisted KW - Mammography -- Classification KW - Radiographic Image Enhancement KW - Algorithms KW - Decision Trees KW - Evaluation Research KW - Sensitivity and Specificity KW - Predictive Value of Tests KW - ROC Curve KW - Human SP - 613 EP - 625 JO - Journal of Digital Imaging JF - Journal of Digital Imaging JA - J DIGIT IMAGING VL - 28 IS - 5 CY - , PB - Springer Science & Business Media B.V. AB - Breast cancer is becoming a leading death of women all over the world; clinical experiments demonstrate that early detection and accurate diagnosis can increase the potential of treatment. In order to improve the breast cancer diagnosis precision, this paper presents a novel automated segmentation and classification method for mammograms. We conduct the experiment on both DDSM database and MIAS database, firstly extract the region of interests (ROIs) with chain codes and using the rough set (RS) method to enhance the ROIs, secondly segment the mass region from the location ROIs with an improved vector field convolution (VFC) snake and following extract features from the mass region and its surroundings, and then establish features database with 32 dimensions; finally, these features are used as input to several classification techniques. In our work, the random forest is used and compared with support vector machine (SVM), genetic algorithm support vector machine (GA-SVM), particle swarm optimization support vector machine (PSO-SVM), and decision tree. The effectiveness of our method is evaluated by a comprehensive and objective evaluation system; also, Matthew's correlation coefficient (MCC) indicator is used. Among the state-of-the-art classifiers, our method achieves the best performance with best accuracy of 97.73 %, and the MCC value reaches 0.8668 and 0.8652 in unique DDSM database and both two databases, respectively. Experimental results prove that the proposed method outperforms the other methods; it could consider applying in CAD systems to assist the physicians for breast cancer diagnosis. SN - 0897-1889 AD - School of Information Science and Engineering, Lanzhou University, No. 222, South Tianshui Road Lanzhou 730000 People's Republic of China U2 - PMID: 25776767. DO - 10.1007/s10278-015-9778-4 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109465612&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 110306310 T1 - Breast cancer prognostic markers: an overview of a changing menu. AU - Gökmen-Polar, Yesim AU - Badve, Sunil Y1 - 2015/10// N1 - Accession Number: 110306310. Language: English. Entry Date: 20151018. Revision Date: 20171024. Publication Type: Article; CEU; exam questions. Journal Subset: Allied Health; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Laboratory Diagnosis; Oncologic Care. NLM UID: 0225602. KW - Breast Neoplasms -- Prognosis KW - Tumor Markers, Biological -- Blood KW - Recurrence -- Risk Factors KW - Breast Neoplasms -- Risk Factors KW - Breast Neoplasms -- Classification KW - Neoplasm Staging KW - Neoplasm Grading KW - Decision Support Techniques KW - Receptors, Cell Surface -- Blood KW - HER-2-neu Oncogene KW - Breast Neoplasms -- Pathology KW - Mutation KW - Molecular Diagnostic Techniques KW - Sequence Analysis KW - Risk Assessment KW - Tumor Markers, Biological -- Analysis KW - Education, Continuing (Credit) SP - 8 EP - 14 JO - MLO: Medical Laboratory Observer JF - MLO: Medical Laboratory Observer JA - MLO VL - 47 IS - 10 CY - Sarasota, Florida PB - NP Communications, LLC AB - The article presents information on the prognostic markers of breast cancer. Topics include the traditional prognostic factors such as tumor size, lymph node status, and distant metastases presence, the Nottingham prognostic index (NPI) tool, and traditional molecular markers like estrogen receptor (ER) and progesterone receptor (PR). It also discusses immunohistochemistry (IHC), next-generation sequencing (NGS), and hormone receptor and human epidermal growth factor status (HER2). SN - 0580-7247 AD - Assistant Scientist of Medicine, Indiana University School of Medicine AD - Professor, Departments of Pathology and Laboratory Medicine and Internal Medicine, Indiana University Simon Cancer Center AD - Director of Translational Genomics Core, Indiana University Simon Cancer Center UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=110306310&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 109625278 T1 - Breast cancer therapy planning - a novel support concept for a sequential decision making problem. AU - Scherrer, Alexander AU - Schwidde, Ilka AU - Dinges, Andreas AU - Rüdiger, Patrick AU - Kümmel, Sherko AU - Küfer, Karl-Heinz Y1 - 2015/09// N1 - Accession Number: 109625278. Language: English. Entry Date: 20150923. Revision Date: 20171025. Publication Type: journal article; research. Journal Subset: Biomedical; Continental Europe; Double Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Health Services Administration; Peer Reviewed. NLM UID: 9815649. SP - 389 EP - 405 JO - Health Care Management Science JF - Health Care Management Science JA - HEALTH CARE MANAGE SCI VL - 18 IS - 3 CY - , PB - Springer Science & Business Media B.V. AB - Breast cancer is the most common carcinosis with the largest number of mortalities in women. Its therapy comprises a wide spectrum of different treatment modalities a breast oncologist decides about for the individual patient case. These decisions happen according to medical guide lines, current scientific publications and experiences acquired in former cases. Clinical decision making therefore involves the time-consuming search for possible therapy options and their thorough testing for applicability to the current patient case.This research work addresses breast cancer therapy planning as a multi-criteria sequential decision making problem. The approach is based on a data model for patient cases with therapy descriptions and a mathematical notion for therapeutic relevance of medical information. This formulation allows for a novel decision support concept, which targets at eliminating observed weaknesses in clinical routine of breast cancer therapy planning. SN - 1386-9620 U2 - PMID: 25315184. DO - 10.1007/s10729-014-9302-2 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109625278&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 109935552 T1 - Primary Breast Cancer Decision-making Among Chinese American Women. AU - Lee, Shiu-yu C. Katie AU - Knobf, M. Tish Y1 - 2015/09//Sep/Oct2015 N1 - Accession Number: 109935552. Language: English. Entry Date: 20151030. Revision Date: 20151030. Publication Type: Article; pictorial; research; tables/charts. Journal Subset: Core Nursing; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Nursing; Peer Reviewed; USA. Special Interest: Oncologic Care; Women's Health. Instrumentation: Breast Cancer Decision-Making Questionnaire; Decisional Conflict Scale (DCS) [Chinese]; Decisional Regret Scale (DRS); Post-Decisional Satisfaction Scalet Cancer Decision-making Questionnaire (BCDMQ)-Postdecision Version. NLM UID: 0376404. KW - Decision Making, Patient KW - Breast Neoplasms KW - Cancer Patients KW - Patient Attitudes KW - Human KW - Female KW - Adult KW - Middle Age KW - Cross Sectional Studies KW - Correlational Studies KW - New York KW - Questionnaires KW - Cultural Competence KW - Snowball Sample KW - Summated Rating Scaling KW - Coefficient Alpha KW - Spearman's Rank Correlation Coefficient KW - Criterion-Related Validity KW - Reliability KW - Descriptive Statistics KW - Data Analysis Software KW - Wilcoxon Rank Sum Test KW - Kruskal-Wallis Test SP - 391 EP - 401 JO - Nursing Research JF - Nursing Research JA - NURS RES VL - 64 IS - 5 CY - Baltimore, Maryland PB - Lippincott Williams & Wilkins AB - Background: Decision-making for cancer treatment is a complex, informational process. Lower satisfaction, higher decision regret, and poorer quality of life are potential adverse outcomes. Objectives: The aim of the study was to describe breast cancer treatment decision outcomes and examine factors associated with decision outcomes of satisfaction and regret in Chinese American women. Methods: A cross-sectional, correlational design was used. A sample of 123 self-identified Chinese American women with early-stage breast cancer was recruited from the greater New York metropolitan area. The Breast Cancer Decision-Making Questionnaire, Decisional Conflict Scale, and Decisional Regret Scale--that were written in Chinese with equivalence from back-translation--were used to measure the factors in the decision-making process and the decisional outcome. Multiple, linear regression was used to identify predictors for decisional outcomes. Results: The mean age of the subjects was 48.7 years (SD=9.3 years), the majority of whom were married (80%) and not working (63%), and about half spoke Cantonese or Mandarin as their daily language. The women reported a low to moderate level of decisional conflict, postdecisional dissatisfaction, and regret with their decision. However, the women who had greater decisional conflict, who had more difficulty in communicating with their physician, who had limited English fluency, and who were financially dependent and less involved in decision-making had lower satisfaction and more regret with their treatment decision. Discussion: Limited English fluency among Chinese American women negatively affected communication during the physician consultation about breast cancer treatment options, and financial barriers were also associated with lower postdecisional satisfaction and higher regret. Culturally sensitive decision support interventions are needed for Asian American women to make an informed, satisfied breast cancer treatment decision. SN - 0029-6562 AD - Associate Professor, National Taipei University of Nursing and Health Sciences, Taiwan AD - Professor, Yale University School of Nursing, Orange, Connecticut U2 - PMID: 26325281. DO - 10.1097/NNR.0000000000000116 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109935552&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 109816370 T1 - Social disclosure about lymphoedema symptoms: A qualitative study among Japanese breast cancer survivors. AU - Tsuchiya, Miyako AU - Horn, Sandra AU - Ingham, Roger Y1 - 2015/09// N1 - Accession Number: 109816370. Language: English. Entry Date: 20150709. Revision Date: 20170222. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care; Psychiatry/Psychology. NLM UID: 9604099. KW - Cancer Survivors KW - Self Disclosure KW - Lymphedema -- Symptoms KW - Human KW - Breast Neoplasms KW - Japan KW - Qualitative Studies KW - Social Networks KW - Female KW - Thematic Analysis KW - Decision Making KW - Adult KW - Middle Age KW - Aged KW - Focus Groups KW - Audiorecording KW - Psychological Theory KW - Community Role KW - Attitude to Illness KW - Support, Psychosocial SP - 680 EP - 684 JO - Psychology, Health & Medicine JF - Psychology, Health & Medicine JA - PSYCHOL HEALTH MED VL - 20 IS - 6 CY - Oxfordshire, PB - Routledge AB - Disclosing illness-related problems is the first step in help-seeking. The aim of this qualitative study was to explore Japanese breast cancer (BC) survivors’ decision-making about disclosure of lymphoedema symptoms to people in their social networks. A total of ten women participated in group discussions in Japan. A dual analytic approach, thematic analysis and conceptual analysis, was applied to the transcripts. Two themes (perceived responsibility of social roles within the family and unsupportive reactions to BC from others) affected participants’ decision-making. Support programs for Japanese BC survivors who feel unable to disclose lymphoedema symptoms to family members are suggested. SN - 1354-8506 AD - Graduate School of Nursing, Chiba University, Inohana 1-8-1, Chuo-ku,Chiba260-8672, Japan AD - School of Psychology, University of Southampton, Highfield, Southampton,HampshireSO17 1BJ, UK U2 - PMID: 25482185. DO - 10.1080/13548506.2014.986140 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109816370&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 109821259 T1 - Development and piloting of a decision aid for women considering participation in the Sentinel Node Biopsy versus Axillary Clearance 2 breast cancer trial...7th Annual Symposium on Statistical Issues in Clinical Trials, Pennsylvania, April 2014 AU - Juraskova, Ilona AU - Butow, Phyllis AU - Fisher, Alana AU - Bonner, Carissa AU - Anderson, Caroline AU - Bu, Stella AU - Scarlet, Jenni AU - Stockler, Martin R. AU - Wetzig, Neil AU - Ung, Owen AU - Campbell, Ian Y1 - 2015/08// N1 - Accession Number: 109821259. Language: English. Entry Date: 20150731. Revision Date: 20150923. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Europe; UK & Ireland. Instrumentation: Control preferences scale (Degner et al); Six-item Short Form of the State Trait Anxiety Inventory; Quality of Informed Consent Scale ¿ Part B.. Grant Information: This work was supported by the NHMRC Clinical Trials Centre at The University of Sydney (Consultancy; to I.J. and P.B.).. NLM UID: 101285473. KW - Decision Making, Patient -- Australia KW - Breast Neoplasms -- Surgery -- Australia KW - Sentinel Lymph Node Biopsy KW - Axilla KW - Human KW - Randomized Controlled Trials KW - Semi-Structured Interview KW - Psychological Tests KW - Data Analysis Software KW - Australia KW - Anxiety KW - Funding Source SP - 409 EP - 417 JO - Clinical Trials JF - Clinical Trials JA - CLIN TRIALS VL - 12 IS - 4 CY - PB - Sage Publications, Ltd. SN - 1740-7745 AD - Centre for Medical Psychology and Evidence-Based Decision Making (CeMPED), School of Psychology, The University of Sydney, Sydney, NSW, Australia AD - Breast Cancer Centre, Waikato Hospital, Hamilton, New Zealand AD - NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia AD - Princess Alexandra Hospital, Brisbane, QLD, Australia AD - Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia; Faculty of Medicine and Biomedical Sciences, University of Queensland, Brisbane, QLD, Australia DO - 10.1177/1740774515586404 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109821259&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 109749256 T1 - Towards informed decisions on breast cancer screening: Development and pilot testing of a decision aid for Chinese women. AU - Wong, Irene O L AU - Lam, Wendy W T AU - Wong, Cheuk Nam AU - Cowling, Benjamin J AU - Leung, Gabriel M AU - Fielding, Richard Y1 - 2015/08// N1 - Accession Number: 109749256. Language: English. Entry Date: 20150923. Revision Date: 20170104. Publication Type: journal article. Journal Subset: Core Nursing; Europe; Health Promotion/Education; Nursing; Peer Reviewed; UK & Ireland. NLM UID: 8406280. SP - 961 EP - 969 JO - Patient Education & Counseling JF - Patient Education & Counseling JA - PATIENT EDUC COUNS VL - 98 IS - 8 PB - Elsevier B.V. AB - Objective: To pilot-test a novel, self-use breast cancer (BC) screening decision aid (DA) targeting Hong Kong (HK) Chinese women at average risk of BC.Methods: Women were recruited through a population-based telephone survey using random digit dialling between October 2013 and January 2014. Eligible participants completed our baseline survey and then received the DA by post. Participants (n=90) completed follow-up telephone interviews one month later.Results: Most participants thought that all/most DA content was presented clearly (86.7%), and was useful in helping women make screening-related decisions (88.9%). It also achieved its expected impact of improving informed decision-making and increasing shared-participation preference without increasing participants' anxiety levels. Participants showed a modest non-statistical increase in their screening knowledge scores. Older women rated the perceived severity of a BC diagnosis as significantly lower, and more educated women reported significantly lower perceived anxiety about the disease.Conclusion: Our DA appears acceptable and feasible for self-use by HK Chinese women who need to make an informed decision about BC screening without increasing overall anxiety levels.Practice Implications: This study supports the potential of self-use DAs for cancer screening-related decision support in a Chinese population. SN - 0738-3991 U2 - PMID: 25959986. DO - 10.1016/j.pec.2015.04.014 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109749256&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 109606748 T1 - The information and decision support needs of older women (>75 yrs) facing treatment choices for breast cancer: a qualitative study. AU - Burton, Maria AU - Collins, Karen Anna AU - Lifford, Kate Joanna AU - Brain, Kate AU - Wyld, Lynda AU - Caldon, L AU - Gath, Jacqui AU - Revell, Deirdre AU - Reed, Malcolm William Y1 - 2015/08// N1 - Accession Number: 109606748. Language: English. Entry Date: 20150923. Revision Date: 20170929. Publication Type: journal article. Journal Subset: Biomedical; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care; Psychiatry/Psychology. Grant Information: RP-PG-1209-10071//Department of Health/United Kingdom. NLM UID: 9214524. SP - 878 EP - 884 JO - Psycho-Oncology JF - Psycho-Oncology JA - PSYCHO ONCOL VL - 24 IS - 8 CY - Hoboken, New Jersey PB - John Wiley & Sons, Inc. AB - Objective: Primary Endocrine Therapy (PET) is a good alternative to surgery for breast cancer in older frailer women. Overall survival rates are equivalent although rates of local control are inferior. There is little research regarding the decision support needs of older patients faced with this choice. This qualitative study aimed to explore these among older breast cancer patients offered a choice of treatment, as the basis to develop an appropriate decision support tool.Methods: Semi-structured interviews were undertaken with older women (>75 years) with breast cancer who had been offered a choice of PET or surgery at diagnosis. Women's involvement in their treatment decision and support for the process were explored and analysed using framework analysis.Results: Thirty-three interviews were undertaken (median age 82, range 75-95 years, 22 PET, 11 surgery). Most women, regardless of treatment choice, wanted tailored information about the different treatment options, their impact on independence, the practicalities of treatment and the risk of recurrence and spread. Surgery was the treatment of choice in women wanting optimal disease control; those choosing PET felt that they were 'too old' for surgery and wanted minimal disruption.Conclusions: Older women described making active treatment decisions. However, some knowledge was inaccurate. Women wanted information and decision support from their clinicians along with a specific tailored information booklet to support this process. SN - 1057-9249 AD - Sheffield Hallam, University Centre for Health and Social Care Research Montgomery House, Sheffield, South Yorkshire, United Kingdom. AD - Cardiff University, Institute of Primary Care and Public Health, School of Medicine, Cardiff, United Kingdom. AD - University of Sheffield, Royal Hallamshire Hospital, Sheffield, United Kingdom. AD - University of Sheffield, Sheffield, United Kingdom. AD - North Trent Cancer Network Consumer Research Panel, Sheffield, United Kingdom. AD - University of Sheffield, Academic Surgical Oncology Unit, Sheffield, United Kingdom. U2 - PMID: 25534045. DO - 10.1002/pon.3735 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109606748&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 109619721 T1 - Physicians' Attitudes Towards the Advice of a Guideline-Based Decision Support System: A Case Study With OncoDoc2 in the Management of Breast Cancer Patients. AU - Bouaud, Jacques AU - Spano, Jean-Philippe AU - Lefranc, Jean-Pierre AU - Cojean-Zelek, Isabelle AU - Blaszka-Jaulerry, Brigitte AU - Zelek, Laurent AU - Durieux, Axel AU - Tournigand, Christophe AU - Rousseau, Alexandra AU - Vandenbussche, Pierre-Yves AU - Séroussi, Brigitte Y1 - 2015/08// N1 - Accession Number: 109619721. Language: English. Entry Date: 20150923. Revision Date: 20160801. Publication Type: Journal Article. Journal Subset: Computer/Information Science; Continental Europe; Editorial Board Reviewed; Europe; Peer Reviewed. Special Interest: Informatics. NLM UID: 9214582. SP - 264 EP - 269 JO - Studies in Health Technology & Informatics JF - Studies in Health Technology & Informatics JA - STUD HEALTH TECHNOL INFORM VL - 216 PB - IOS Press SN - 0926-9630 AD - AP-HP, DRCD, Paris, France; Sorbonne Universités, UPMC Université Paris 06, UMR_S 1142, LIMICS, Paris, France; INSERM, U1142, LIMICS, Paris, France; Université Paris 13, Sorbonne Paris Cité, LIMICS (UMR_S 1142), Bobigny, France AD - Sorbonne Universités, UPMC Université Paris 06, UFR de Médecine, Paris, France; AP-HP, Hôpital Pitié-Salpétrière, Service d'Oncologie médicale, Paris, France AD - Sorbonne Universités, UPMC Université Paris 06, UFR de Médecine, Paris, France; AP-HP, Hôpital Pitié-Salpétrière, Service de Chirurgie et Cancérologie gynécologique et mammaire, Paris, France AD - Hôpital des Diaconesses, Pôle oncologie médicale, Paris, France AD - CH Lagny Marne la Vallée, Service de Radiothérapie-Oncologie, Lagny, France AD - Université Paris 13, UFR SMBH, Bobigny, France; AP-HP, Hôpital Avicenne, Service d'oncologie médicale, Bobigny, France AD - Institut de Cancérologie des Peupliers, Paris, France AD - AP-HP, Hôpital St-Antoine, Service d'oncologie médicale, Paris, France AD - AP-HP, Hôpital St-Antoine, URC-EST, Paris, France AD - Fujitsu (Ireland) Limited, Swords, Co. Dublin, Ireland AD - Sorbonne Universités, UPMC Université Paris 06, UMR_S 1142, LIMICS, Paris, France; INSERM, U1142, LIMICS, Paris, France; Université Paris 13, Sorbonne Paris Cité, LIMICS (UMR_S 1142), Bobigny, France; AP-HP, Hôpital Tenon, Département de Santé Publique, Paris, France; APREC, Paris, France DO - 10.3233/978-1-61499-564-7-264 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109619721&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 109592161 T1 - The evolving role of adjuvant radiotherapy for elderly women with early-stage breast cancer. AU - Rutter, Charles E AU - Lester-Coll, Nataniel H AU - Mancini, Brandon R AU - Corso, Christopher D AU - Park, Henry S AU - Yeboa, Debra N AU - Gross, Cary P AU - Evans, Suzanne B Y1 - 2015/07/15/ N1 - Accession Number: 109592161. Language: English. Entry Date: 20150923. Revision Date: 20160714. Publication Type: journal article. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Oncologic Care. NLM UID: 0374236. SP - 2331 EP - 2340 JO - Cancer (0008543X) JF - Cancer (0008543X) JA - CANCER VL - 121 IS - 14 CY - Hoboken, New Jersey PB - John Wiley & Sons, Inc. AB - Background: Elderly patients with early-stage breast cancer (ESBC) derive a local control benefit from radiotherapy (RT) after lumpectomy, without any apparent effect on overall survival. Therefore, the use of RT is controversial. In the current study, the authors characterized updated trends in RT for elderly patients with estrogen receptor (ER)-positive ESBC.Methods: Patients aged ≥70 years with ER-positive ESBC measuring ≤2 cm after lumpectomy with negative resection margins and known RT details were identified in the National Cancer Data Base. Patients were classified by year of diagnosis and segregated into 3 groups relative to the initial publication and updated presentation of the Cancer and Leukemia Group B (CALGB) 9343 trial. RT use overall, prescription of hypofractionated RT, and use of boost RT were compared between groups using logistic regression analysis, and the influence of clinicopathologic covariates was determined with multivariable logistic regression analysis.Results: A total of 122,796 elderly patients with ER-positive ESBC who were diagnosed between 1998 and 2011 were identified. Overall, 84,649 patients (68.9%) received adjuvant RT, with a decline observed between successive cohorts (71.3% in the pre-initial publication cohort, 69.5% in the pre-update cohort, and 64.7% in the post-update cohort; P <.001). Hypofractionated RT use increased among treated patients over time (P<.001). Boost RT was used in 67.5% of patients, with a decline noted between the pre-update and post-update cohorts (68.7% vs 57.7%; P<.001). Overall RT use as well as use of boost RT were found to be lower among older patients and those with lower-grade or smaller tumors (P<.001), whereas hypofractionated RT was used more commonly in these groups (P<.001).Conclusions: RT use appears to have declined in elderly patients with ER-positive ESBC, a finding that is reflective of evidence-based practice integrating mature trial data. Further research is needed to develop tools to aid in the decision-making process regarding the delivery or avoidance of RT in this setting. SN - 0008-543X U2 - PMID: 25810128. DO - 10.1002/cncr.29377 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109592161&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 108723517 T1 - P0168 Role of multidisciplinary teams in breast cancer adjuvant therapy: An analysis of decision-making related factors. AU - Liang, Yue AU - Chen, Xiaosong AU - Wu, Jiayi AU - Huang, Ou AU - Zong, Yu AU - Mao, Yan AU - Li, Yafen AU - Chen, Weiguo AU - Zhu, Li AU - He, Jianrong AU - Fang, Qiong AU - Zhang, Nan AU - Shen, Kunwei Y1 - 2015/07/02/Jul2015 Supplement 2 N1 - Accession Number: 108723517. Language: English. Entry Date: In Process. Revision Date: 20150806. Publication Type: Article. Supplement Title: Jul2015 Supplement 2. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. NLM UID: 9005373. SP - e32 EP - e32 JO - European Journal of Cancer JF - European Journal of Cancer JA - EUR J CANCER VL - 51 PB - Pergamon Press - An Imprint of Elsevier Science AB - Background When deciding the adjuvant treatment strategy for breast cancer patients, the attending doctor’s opinion may be affected by the result from multidisciplinary team (MDT) consultation. We aimed is to find out which clinicopathological factors would be more likely to affect initial treatment strategy from the attending doctor and the significance of MDT consultation in it. Methods In 2013, 410 patients with invasive breast cancer received MDT consultation at the Comprehensive Breast Health Center, Shanghai Ruijin Hospital. Chi-square analysis and multivariate logistic regression analysis were used to define the factors associated with the disagreement between the attending doctor and MDT panel. Findings Disagreement between the attending doctor and MDT panel were seen in 81 cases (19.8%), which related to all three categories in adjuvant treatment: chemotherapy (4.1%), radiation therapy (5.4%), and endocrine therapy (5.2%). For chemotherapy, molecular subtypes ( X 2 = 10.669, p = 0.014) were significantly correlated with the disagreement, as was lymph node staging ( X 2 = 6.168, p = 0.046) for radiation therapy. For endocrine therapy, menstrual status ( X 2 = 3.927, p = 0.048) and family history ( X 2 = 4.725, p = 0.03) were significantly correlated with disagreement. In multivariate logistic regression analysis, changing of endocrine therapy regimens was more likely to be seen in postmenopausal patients than in premenopausal patients (odds ratio (OR) 3.298; 95% confidence interval (CI) 1.065–10.207; p = 0.038). Family history was also a predictive factor of decision changing (OR 0.183; 95% CI 0.051–0.653; p = 0.009). Interpretation Molecular subtypes, lymph node staging, and menstrual status were crucial factors in the breast cancer MDT decision-making process and most controversial cases presented with these factors. More attention should be paid to these factors to offer standardised and individualised adjuvant therapy for patients with breast cancer. SN - 0959-8049 AD - Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China DO - 10.1016/j.ejca.2015.06.095 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=108723517&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 108836017 T1 - Why Breast Cancer Risk by the Numbers Is Not Enough: Evaluation of a Decision Aid in Multi-Ethnic, Low-Numerate Women. AU - Kukafka, Rita AU - Yi, Haeseung AU - Xiao, Tong AU - Thomas, Parijatham AU - Aguirre, Alejandra AU - Smalletz, Cindy AU - David, Raven AU - Crew, Katherine Y1 - 2015/07// N1 - Accession Number: 108836017. Language: English. Entry Date: 20150923. Revision Date: 20161118. Publication Type: journal article. Journal Subset: Biomedical; Canada; Computer/Information Science; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed. Grant Information: R01 CA177995-01A1/CA/NCI NIH HHS/United States. NLM UID: 100959882. KW - Breast Neoplasms -- Epidemiology KW - Consumer Health Information -- Methods KW - Breast Neoplasms -- Ethnology KW - Decision Support Techniques KW - Human KW - Ethnic Groups KW - Focus Groups KW - Risk Factors KW - Middle Age KW - United States KW - Female KW - Early Detection of Cancer KW - Risk Assessment KW - Questionnaires KW - Funding Source KW - Paired T-Tests KW - McNemar's Test SP - 1 EP - 1 JO - Journal of Medical Internet Research JF - Journal of Medical Internet Research JA - J MED INTERNET RES VL - 17 IS - 7 CY - Toronto, Ontario PB - JMIR Publications Inc. AB - Background: Breast cancer risk assessment including genetic testing can be used to classify people into different risk groups with screening and preventive interventions tailored to the needs of each group, yet the implementation of risk-stratified breast cancer prevention in primary care settings is complex.Objective: To address barriers to breast cancer risk assessment, risk communication, and prevention strategies in primary care settings, we developed a Web-based decision aid, RealRisks, that aims to improve preference-based decision-making for breast cancer prevention, particularly in low-numerate women.Methods: RealRisks incorporates experience-based dynamic interfaces to communicate risk aimed at reducing inaccurate risk perceptions, with modules on breast cancer risk, genetic testing, and chemoprevention that are tailored. To begin, participants learn about risk by interacting with two games of experience-based risk interfaces, demonstrating average 5-year and lifetime breast cancer risk. We conducted four focus groups in English-speaking women (age ≥18 years), a questionnaire completed before and after interacting with the decision aid, and a semistructured group discussion. We employed a mixed-methods approach to assess accuracy of perceived breast cancer risk and acceptability of RealRisks. The qualitative analysis of the semistructured discussions assessed understanding of risk, risk models, and risk appropriate prevention strategies.Results: Among 34 participants, mean age was 53.4 years, 62% (21/34) were Hispanic, and 41% (14/34) demonstrated low numeracy. According to the Gail breast cancer risk assessment tool (BCRAT), the mean 5-year and lifetime breast cancer risk were 1.11% (SD 0.77) and 7.46% (SD 2.87), respectively. After interacting with RealRisks, the difference in perceived and estimated breast cancer risk according to BCRAT improved for 5-year risk (P=.008). In the qualitative analysis, we identified potential barriers to adopting risk-appropriate breast cancer prevention strategies, including uncertainty about breast cancer risk and risk models, distrust toward the health care system, and perception that risk assessment to pre-screen women for eligibility for genetic testing may be viewed as rationing access to care.Conclusions: In a multi-ethnic population, we demonstrated a significant improvement in accuracy of perceived breast cancer risk after exposure to RealRisks. However, we identified potential barriers that suggest that accurate risk perceptions will not suffice as the sole basis to support informed decision making and the acceptance of risk-appropriate prevention strategies. Findings will inform the iterative design of the RealRisks decision aid. SN - 1438-8871 AD - Columbia University, College of Physicians and Surgeons, Biomedical Informatics, Mailman School of Public Health, Sociomedical Sciences, New York, NY, United States AD - Columbia University, Teachers College, Health and Behavior Studies, New York, NY, United States AD - Mailman School of Public Health, Columbia University, Epidemiology, New York, NY, United States AD - MD Anderson Cancer Center, Department of Clinical Cancer Prevention, Houston, TX, United States AD - Columbia University, Community Engagement Resource, Irving Institute for Clinical & Translational Research, New York, NY, United States AD - Columbia University, Center for New Media Teaching and Learning, New York, NY, United States AD - Columbia University, Biomedical Informatics, New York, NY, United States AD - Columbia University, College of Physicians and Surgeons, Medicine, Herbert Irving Comprehensive Cancer Center, New York, NY, United States U2 - PMID: 26175193. DO - 10.2196/jmir.4028 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=108836017&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 103792245 T1 - Do patients use decision and communication aids as prompted when meeting with breast cancer specialists? AU - Volz, Shelley AU - Moore, Dan H. AU - Belkora, Jeffrey K. Y1 - 2015/06// N1 - Accession Number: 103792245. Language: English. Entry Date: 20150506. Revision Date: 20160531. Publication Type: Journal Article; research; tables/charts. Journal Subset: Europe; Health Services Administration; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care. Grant Information: Informed Medical Decisions Foundation (grant 0015). NLM UID: 9815926. KW - Breast Neoplasms -- Therapy KW - Decision Support Techniques -- Utilization KW - Communication Skills Training KW - Decision Making KW - Program Implementation KW - Program Evaluation KW - Surveys KW - Descriptive Statistics KW - Logistic Regression KW - Fisher's Exact Test KW - Chi Square Test KW - Middle Age KW - Female KW - Human KW - Funding Source SP - 379 EP - 391 JO - Health Expectations JF - Health Expectations JA - HEALTH EXPECTATIONS VL - 18 IS - 3 CY - Malden, Massachusetts PB - Wiley-Blackwell AB - Background Our breast cancer clinic promotes patient use of decision and communication aids ( DAs/ CAs) through two mechanisms: coaching and prompting. From January through September 2010, we provided services to 462 of 1106 new visitors (42%). Of those 462 visitors, 267 (58%) received coaching. For the remainder (195 or 42%), the best we could do was prompt them to self-administer the DA and CAs. Objective We wanted to learn whether patients prompted to use DAs/ CAs did so. Methods We surveyed prompted patients after their visits. We asked how much of each DA they reviewed, whether they listed questions, made notes and audio-recorded their consultations. We tallied frequencies and explored associations using logistic regression. Results Of the 195 prompted patients, 82 responded to surveys (42%). Nearly all (66/73 or 90%) reported reviewing some or all of the booklets and 52/73 (71%) reported viewing some or all of the DVDs. While 63/78 (81%) responded that they wrote a question list, only 14/61 (23%) said they showed it to their doctor. Two-thirds (51/77 or 66%) said someone took notes, but only 16/79 (20%) reported making audio recordings. Discussion More patients reported following prompts to use DAs than CAs. Few reported showing question lists to physicians or recording their visits. Our exploratory analyses surfaced associations between using CAs and race/ethnicity or education that merit further investigation. Conclusion Prompting patients assures better use of decision than communication aids. Clinicians may need to take a more active role to ensure patients receive adequate notes and recordings. SN - 1369-6513 AD - Institute for Health Policy Studies, University of California AD - HDF Comprehensive Cancer Center, University of California AD - Surgery and Health Policy U2 - PMID: 23294338. DO - 10.1111/hex.12042 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103792245&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 109602259 T1 - Primary systemic therapy for breast cancer: Does the patient's involvement in decision-making create a new future? AU - Tokés, Tímea AU - Torgyík, László AU - Szentmártoni, Gyöngyvér AU - Somlai, Krisztián AU - Tóth, Andrea AU - Kulka, Janina AU - Dank, Magdolna AU - Tőkés, Tímea Y1 - 2015/06// N1 - Accession Number: 109602259. Language: English. Entry Date: 20150923. Revision Date: 20170104. Publication Type: journal article; review. Journal Subset: Core Nursing; Europe; Health Promotion/Education; Nursing; Peer Reviewed; UK & Ireland. NLM UID: 8406280. SP - 695 EP - 703 JO - Patient Education & Counseling JF - Patient Education & Counseling JA - PATIENT EDUC COUNS VL - 98 IS - 6 PB - Elsevier B.V. AB - Objective: Primary systemic therapy (PST) followed by surgery is the standard initial treatment for locally advanced breast cancer (LABC). However, some patients are averse to mastectomy or breast-conserving surgery and do not consent to these procedures. The reasons for this controversial decision, the factors influencing the decision-making and optimal solutions for decision aiding need to be investigated.Methods: We addressed these questions by a review of literature on the possibilities associated with different patient choices and subsequent treatment options in relation to LABC.Results: A total of 5 reviews and 22 clinical studies were summarized in relation to decision making and the most successful decision aids. A discussion is given of the issues of those few patients who cannot be convinced to undergo surgery.Conclusion: Currently there is no guideline for the treatment of patients who reject the surgical procedures after PST. Medical oncologists should be able to apply decision aid modalities in a personalized manner to give all needed information to their patients thereby ensuring a deliberate decision-making process, facilitating acceptance of a need for surgery, and thus improving the chances of prolonged survival.Practice Implications: Currently multidisciplinary tumor boards are the most suitable decision aids in oncological practice. SN - 0738-3991 AD - Semmelweis University, 1st Department of Internal Medicine, Oncology Division, Budapest, Hungary AD - Semmelweis University, 1st Department of Internal Medicine, Oncology Division, Budapest, Hungary. Electronic address: tokes.timea@med.semmelweis-univ.hu. AD - Semmelweis University, 1st Department of Internal Medicine, Oncology Division, Budapest, Hungary. AD - Semmelweis University, 1st Department of Internal Medicine, Oncology Division, Budapest, Hungary; St. Margaret Hospital, Surgical Division, Budapest, Hungary. AD - Semmelweis University, 2nd Department of Pathology, Budapest, Hungary. U2 - PMID: 25749023. DO - 10.1016/j.pec.2015.02.012 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109602259&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 103802925 T1 - Tamoxifen for 5 years reduced 16-year risk for breast cancer in women at increased risk. AU - Parsons, Heather AU - Stearns, Vered Y1 - 2015/05/19/ N1 - Accession Number: 103802925. Language: English. Entry Date: 20150521. Revision Date: 20150710. Publication Type: Journal Article; abstract; commentary; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Evidence-Based Practice; Oncologic Care; Women's Health. NLM UID: 9104824. KW - Breast Neoplasms -- Prevention and Control KW - Tamoxifen -- Therapeutic Use KW - Treatment Duration KW - Treatment Outcomes KW - Prospective Studies KW - Randomized Controlled Trials KW - Breast Neoplasms -- Risk Factors KW - Female KW - Adult KW - Middle Age KW - Aged KW - Descriptive Statistics KW - Tamoxifen -- Administration and Dosage KW - Tamoxifen -- Adverse Effects KW - Odds Ratio KW - Survival Analysis KW - Decision Support Techniques KW - Mortality KW - Relative Risk KW - Confidence Intervals KW - Australia KW - Belgium KW - Finland KW - Ireland KW - New Zealand KW - Spain KW - Switzerland KW - United Kingdom SP - 1 EP - 1 JO - ACP Journal Club JF - ACP Journal Club JA - ACP J CLUB VL - 162 IS - 10 CY - Philadelphia, Pennsylvania PB - American College of Physicians SN - 1056-8751 AD - Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, Maryland, USA UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103802925&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 109748043 T1 - Neoadjuvant Treatment Approach: The Rosetta Stone for Breast Cancer? AU - Generali, Daniele AU - Ardine, Mara AU - Strina, Carla AU - Milani, Manuela AU - Cappelletti, Maria Rosa AU - Zanotti, Laura AU - Forti, Michela AU - Bedussi, Francesca AU - Martinotti, Mario AU - Amoroso, Vito AU - Sigala, Sandra AU - Simoncini, Edda AU - Berruti, Alfredo AU - Bottini, Alberto Y1 - 2015/05//2015 May N1 - Accession Number: 109748043. Language: English. Entry Date: 20150923. Revision Date: 20160406. Publication Type: journal article. Journal Subset: Biomedical; USA. Special Interest: Oncologic Care. NLM UID: 9011255. SP - 32 EP - 35 JO - JNCI Monographs JF - JNCI Monographs JA - J NATL CANCER INST MONOGRAPHS VL - 2015 IS - 51 PB - Oxford University Press / USA AB - Breast cancer represents a heterogeneous group of diseases with varied biological features, behavior, and response to therapy; thus, management of breast cancer relies on the availability of robust predictive and prognostic factors to support therapy decision-making. Traditionally, neoadjuvant treatment for breast cancer was preserved for locally advanced, converting an inoperable to a surgical resectable cancer. Neoadjuvant trials, additionally, offer: 1) the opportunity to evaluate new treatment options in a faster way and with fewer patients than large adjuvant trials; 2) to identify and validate the prognostic and predictive value of a marker with its association with clinical outcome in relation to the administered treatment. In this setting, thanks to new, affordable technologies which help to detail the molecular profiles of tumors, new trial designs based on new target therapies, like window-of-opportunity, are also suggested, as they represent the chance to identify tumor sensitivity or to overcome tumor resistance to the treatment used, based on its interaction with tumor biology in early tumor stages. However, clinicians and researchers should pay particular attention: In this setting, the safety of patients is paramount, given the exposure of potentially curable patients to investigational agents with limited safety experience, the definition of the study population and the study design, such as adaptive strategies, should limit patient exposure to ineffective agents, and intensify safety monitoring in the course of the treatment. Here, issues related to outcome determination in breast cancer, including some critical points of view, are presented. SN - 1052-6773 U2 - PMID: 26063883. DO - 10.1093/jncimonographs/lgv019 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109748043&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 109779282 T1 - Pre-consultation educational group intervention to improve shared decision-making for postmastectomy breast reconstruction: a pilot randomized controlled trial. AU - Causarano, Natalie AU - Platt, Jennica AU - Baxter, Nancy N AU - Bagher, Shaghayegh AU - Jones, Jennifer M AU - Metcalfe, Kelly A AU - Hofer, Stefan O P AU - O'Neill, Anne C AU - Cheng, Terry AU - Starenkyj, Elizabeth AU - Zhong, Toni Y1 - 2015/05// N1 - Accession Number: 109779282. Language: English. Entry Date: 20150703. Revision Date: 20171020. Publication Type: journal article; research; randomized controlled trial. Journal Subset: Biomedical; Continental Europe; Double Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed. Special Interest: Oncologic Care. NLM UID: 9302957. KW - Breast Neoplasms -- Surgery KW - Decision Making KW - Decision Support Techniques KW - Breast Reconstruction -- Education KW - Patient Education KW - Adult KW - Aged KW - Female KW - Attitude to Health KW - Human KW - Consent KW - Mastectomy KW - Middle Age KW - Physician-Patient Relations KW - Pilot Studies KW - Questionnaires KW - Referral and Consultation KW - Self-Efficacy SP - 1365 EP - 1375 JO - Supportive Care in Cancer JF - Supportive Care in Cancer JA - SUPPORT CARE CANCER VL - 23 IS - 5 CY - , PB - Springer Science & Business Media B.V. AB - Purpose: Breast cancer survivors who make preference-sensitive decisions about postmastectomy breast reconstruction often have large gaps in knowledge and undergo procedures that are misaligned with their treatment goals. We evaluated the feasibility and effect of a pre-consultation educational group intervention on the decision-making process for breast reconstruction.Methods: We conducted a pilot randomized controlled trial (RCT) where participants were randomly assigned to the intervention with routine education or routine education alone. The outcomes evaluated were decisional conflict, decision self-efficacy, satisfaction with information, perceived involvement in care, and uptake of reconstruction following surgical consultation. Trial feasibility and acceptability were evaluated, and effect sizes were calculated to determine the primary outcome for the full-scale RCT.Results: Of the 41 patients enrolled, recruitment rate was 72 %, treatment fidelity was 98 %, and retention rate was 95 %. The Cohen's d effect size in reduction of decisional conflict was moderate to high for the intervention group compared to routine education (0.69, 95 % CI = 0.02-1.42), while the effect sizes of increase in decision self-efficacy (0.05, 95 % CI = -0.60-0.71) and satisfaction with information (0.11, 95 % CI = -0.53-0.76) were small. A higher proportion of patients receiving routine education signed informed consent to undergo breast reconstruction (14/20 or 70 %) compared to the intervention group (8/21 or 38 %) P = 0.06.Conclusions: A pre-consultation educational group intervention improves patients' shared decision-making quality compared to routine preoperative patient education. A full-scale definitive RCT is warranted based on high feasibility outcomes, and the primary outcome for the main trial will be decisional conflict. SN - 0941-4355 AD - Division of Plastic & Reconstructive Surgery, Breast Reconstruction Program, University Health Network, 8N871, 200 Elizabeth St., Toronto, ON, M5G 2C4, Canada. U2 - PMID: 25351455. DO - 10.1007/s00520-014-2479-6 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109779282&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 109784889 T1 - Use of a decision aid including information on overdetection to support informed choice about breast cancer screening: a randomised controlled trial. AU - Hersch, Jolyn AU - Barratt, Alexandra AU - Jansen, Jesse AU - Irwig, Les AU - McGeechan, Kevin AU - Jacklyn, Gemma AU - Thornton, Hazel AU - Dhillon, Haryana AU - Houssami, Nehmat AU - McCaffery, Kirsten Y1 - 2015/04/25/ N1 - Accession Number: 109784889. Language: English. Entry Date: 20150522. Revision Date: 20170831. Publication Type: journal article; research; randomized controlled trial. Commentary: Johansson Minna, Brodersen John. Informed choice in screening needs more than information. (LANCET) 4/25/2015; 385 (9978): 1597-1599. Journal Subset: Biomedical; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. NLM UID: 2985213R. KW - Decision Support Techniques KW - Attitude to Health KW - Mammography -- Utilization KW - Breast Neoplasms -- Prevention and Control KW - Breast Neoplasms -- Radiography KW - Decision Making KW - Female KW - Human KW - Middle Age KW - Patient Education KW - Consumer Participation SP - 1642 EP - 1652 JO - Lancet JF - Lancet JA - LANCET VL - 385 North American Edition IS - 9978 CY - Philadelphia, Pennsylvania PB - Lancet AB - Background: Mammography screening can reduce breast cancer mortality. However, most women are unaware that inconsequential disease can also be detected by screening, leading to overdiagnosis and overtreatment. We aimed to investigate whether including information about overdetection of breast cancer in a decision aid would help women aged around 50 years to make an informed choice about breast screening. Methods: We did a community-based, parallel-group, randomised controlled trial in New South Wales, Australia, using a random cohort of women aged 48-50 years. Recruitment to the study was done by telephone; women were eligible if they had not had mammography in the past 2 years and did not have a personal or strong family history of breast cancer. With a computer program, we randomly assigned 879 participants to either the intervention decision aid (comprising evidence-based explanatory and quantitative information on overdetection, breast cancer mortality reduction, and false positives) or a control decision aid (including information on breast cancer mortality reduction and false positives). Participants and interviewers were masked to group assignment. The primary outcome was informed choice (defined as adequate knowledge and consistency between attitudes and screening intentions), which we assessed by telephone interview about 3 weeks after random allocation. The primary outcome was analysed in all women who completed the relevant follow-up interview questions fully. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12613001035718. Findings: Between January, 2014, and July, 2014, 440 women were allocated to the intervention group and 439 were assigned to the control group. 21 women in the intervention group and 20 controls were lost to follow-up; a further ten women assigned to the intervention and 11 controls did not answer all questions on attitudes. Therefore, 409 women in the intervention group and 408 controls were analysed for the primary outcome. 99 (24%) of 409 women in the intervention group made an informed choice compared with 63 (15%) of 408 in the control group (difference 9%, 95% CI 3-14; p=0·0017). Compared with controls, more women in the intervention group met the threshold for adequate overall knowledge (122/419 [29%] vs 71/419 [17%]; difference 12%, 95% CI 6-18; p<0·0001), fewer women expressed positive attitudes towards screening (282/409 [69%] vs 340/408 [83%]; 14%, 9-20; p<0·0001), and fewer women intended to be screened (308/419 [74%] vs 363/419 [87%]; 13%, 8-19; p<0·0001). When conceptual knowledge alone was considered, 203 (50%) of 409 women in the intervention group made an informed choice compared with 79 (19%) of 408 in the control group (p<0·0001). Interpretation: Information on overdetection of breast cancer provided within a decision aid increased the number of women making an informed choice about breast screening. Becoming better informed might mean women are less likely to choose screening. Funding: Australian National Health and Medical Research Council. SN - 0099-5355 U2 - PMID: 25701273. DO - 10.1016/S0140-6736(15)60123-4 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109784889&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 103778478 T1 - Psychometric assessment of the Chinese version of the decisional conflict scale in Chinese women making decision for breast cancer surgery. AU - Lam, Wendy W. T. AU - Kwok, Marie AU - Liao, Qiuyan AU - Chan, Miranda AU - Or, Amy AU - Kwong, Ava AU - Suen, Dacita AU - Fielding, Richard Y1 - 2015/04// N1 - Accession Number: 103778478. Language: English. Entry Date: 20150401. Revision Date: 20160331. Publication Type: Journal Article; research; tables/charts. Journal Subset: Europe; Health Services Administration; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care. Instrumentation: Hospital Anxiety and Depression Scale (HADS) [Chinese]; Decisional Conflict Scale (DCS) [Chinese]. Grant Information: This work was supported by a grant #07080651 from Health and Health Services Research Fund, The Government of Hong Kong, Hong Kong SAR.. NLM UID: 9815926. KW - Instrument Validation KW - Decision Making, Patient KW - Breast Neoplasms -- Surgery KW - Human KW - Funding Source KW - Hong Kong KW - Scales KW - Cancer Patients KW - Lumpectomy KW - Mastectomy KW - Breast Reconstruction KW - Female KW - Internal Consistency KW - Discriminant Validity KW - Coefficient Alpha KW - Construct Validity KW - Summated Rating Scaling KW - Data Analysis Software KW - Chi Square Test KW - Goodness of Fit Chi Square Test KW - Confidence Intervals KW - Adult KW - Middle Age KW - Aged KW - Aged, 80 and Over KW - T-Tests KW - Factor Analysis SP - 210 EP - 220 JO - Health Expectations JF - Health Expectations JA - HEALTH EXPECTATIONS VL - 18 IS - 2 CY - Malden, Massachusetts PB - Wiley-Blackwell AB - Objective The decisional conflict scale ( DCS) measures the perception of uncertainty in choosing options, factors contributing to decision conflict and effective decision making. This study examined the validity and reliability of the Chinese version of the DCS in Hong Kong Chinese women deciding breast cancer ( BC) surgery. Method A Chinese version of the 16-item DCS was administered to 471 women awaiting initial consultation for BC diagnosis. Confirmatory factor analysis ( CFA) assessed the factor structure. Internal consistency, and convergent and discriminant validities of the factor structure were assessed. Results CFA revealed the original factor structure of the DCS showed poor fit to this sample. Exploratory factor analysis revealed an alternative three-factor structure, Informed and Values Clarity, Uncertainty and Effective Decision and Support, was optimal. Cronbach's alpha ranged from 0.51 to 0.87. Correlations between decision-making difficulties and satisfaction with medical consultation demonstrated acceptable convergent validity. Construct validity was supported by correlations between decision regret and psychological distress. Discriminant validity was supported by differentiation between delaying and non-delaying decision-makers. Conclusions The three-factor DCS-14 is a valid and practical measure for assessing decisional conflict in deciding BC surgery. It shows good potential for use in assessing decision satisfaction for women diagnosed with BC. SN - 1369-6513 AD - Department of Community Medicine and Unit for Behavioural Sciences, Centre for Psycho-oncological Research and Training, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong AD - Department of Surgery, Kwong Wah 3 Hospital Hospital Authority, The University of Hong Kong AD - Department of Surgery, The University of Hong Kong U2 - PMID: 23167846. DO - 10.1111/hex.12021 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103778478&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107786799 T1 - Re: survival outcomes after contralateral prophylactic mastectomy: a decision analysis...J Natl Cancer Inst. 2014 Aug;106(8). pii: dju160. doi: 10.1093/jnci/dju160 AU - Narod, Steven A Y1 - 2015/04//2015 Apr N1 - Accession Number: 107786799. Language: English. Entry Date: 20150501. Revision Date: 20150819. Publication Type: Journal Article; commentary; letter. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Oncologic Care. NLM UID: 7503089. KW - Breast Neoplasms -- Mortality KW - Breast Neoplasms -- Surgery KW - Decision Support Techniques KW - Mastectomy KW - Recurrence -- Prevention and Control KW - Female SP - 1 EP - 1 JO - JNCI: Journal of the National Cancer Institute JF - JNCI: Journal of the National Cancer Institute JA - J NATL CANCER INST VL - 107 IS - 4 PB - Oxford University Press / USA SN - 0027-8874 AD - Familial Breast Cancer Research Unit, Women's College Research Institute steven.narod@wchospital.ca. U2 - PMID: 25870387. DO - jnci/djv092 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107786799&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107786800 T1 - Response...J Natl Cancer Inst. 2014 Aug;106(8). pii: dju160. doi: 10.1093/jnci/dju160; J Natl Cancer Inst. 2015 Apr;107(4). pii: djv092. doi: 10.1093/jnci/djv092 AU - Portschy, Pamela R AU - Kuntz, Karen M AU - Tuttle, Todd M Y1 - 2015/04//2015 Apr N1 - Accession Number: 107786800. Language: English. Entry Date: 20150501. Revision Date: 20150819. Publication Type: Journal Article; commentary; letter. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Oncologic Care. NLM UID: 7503089. KW - Breast Neoplasms -- Mortality KW - Breast Neoplasms -- Surgery KW - Decision Support Techniques KW - Mastectomy KW - Recurrence -- Prevention and Control KW - Female SP - 1 EP - 1 JO - JNCI: Journal of the National Cancer Institute JF - JNCI: Journal of the National Cancer Institute JA - J NATL CANCER INST VL - 107 IS - 4 PB - Oxford University Press / USA SN - 0027-8874 AD - Department of Surgery, University of Minnesota (PRP, TMT);Department of Health Policy and Management, University of Minnesota (KMK). ports001@umn.edu. AD - Department of Surgery, University of Minnesota (PRP, TMT);Department of Health Policy and Management, University of Minnesota (KMK). U2 - PMID: 25870388. DO - jnci/djv093 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107786800&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 103770013 T1 - Developing and Testing a Decision Aid for Use by Providers in Making Recommendations: About Mammography Screening in Older Women. AU - Tisnado, Diana M. AU - Moore, Alison A. AU - Levin, Jennifer R. AU - Rosen, Sonja Y1 - 2015/04// N1 - Accession Number: 103770013. Language: English. Entry Date: 20150316. Revision Date: 20150710. Publication Type: Journal Article; research; tables/charts. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. Special Interest: Gerontologic Care; Oncologic Care; Women's Health. Grant Information: This research was supported by grant #04095295 from the Donald W. Reynolds Foundation as part of the Donald W. Reynolds Consortium to Strengthen Faculty Expertise in Geriatrics in US Academic Health Centers.. NLM UID: 8606502. KW - Decision Support Techniques -- Evaluation KW - Breast Neoplasms -- Diagnosis -- In Old Age KW - Mammography -- Evaluation -- In Old Age KW - Geriatricians -- Psychosocial Factors KW - Funding Source KW - Human KW - Focus Groups KW - Audiorecording KW - Surveys KW - Convenience Sample KW - Aged KW - Aged, 80 and Over KW - Female KW - Male KW - Life Expectancy -- Evaluation KW - Patients -- Psychosocial Factors KW - Comorbidity -- Epidemiology KW - Cognition SP - 343 EP - 358 JO - Journal of Applied Gerontology JF - Journal of Applied Gerontology JA - J APPL GERONTOL VL - 34 IS - 3 CY - Thousand Oaks, California PB - Sage Publications Inc. SN - 0733-4648 AD - University of California, Los Angeles, CA, USA U2 - PMID: 25765821. DO - 10.1177/0733464812467397 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103770013&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 103795922 T1 - The Value of Personalizing Medicine: Medical Oncologists' Views on Gene Expression Profiling in Breast Cancer Treatment. AU - Bombard, Yvonne AU - Rozmovits, Linda AU - Trudeau, Maureen AU - Leighl, Natasha B. AU - Deal, Ken AU - Marshall, Deborah A. Y1 - 2015/04// N1 - Accession Number: 103795922. Language: English. Entry Date: 20150505. Revision Date: 20150710. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Oncologic Care. Grant Information: This study was conducted with the support of funding provided by Cancer Care Ontario and the Ontario Institute for Cancer Research and the Canadian Centre for Applied Research in Cancer Control. Also supported by a fellowship from the Canadian Institutes of Health Research and by a Canada Research Chair in Health Services and Systems Research.. NLM UID: 9607837. KW - Individualized Medicine KW - Breast Neoplasms -- Therapy KW - Physician Attitudes KW - Gene Expression Profiling KW - Breast Neoplasms -- Familial and Genetic KW - Human KW - Multimethod Studies KW - Interviews KW - Thematic Analysis KW - Adult KW - Descriptive Statistics KW - Questionnaires KW - Multicenter Studies KW - Ontario KW - Audiorecording KW - Data Analysis Software KW - Middle Age KW - Aged KW - Decision Making, Clinical KW - Health Care Costs KW - Funding Source SP - 351 EP - 356 JO - Oncologist JF - Oncologist JA - ONCOLOGIST VL - 20 IS - 4 CY - Durham, North Carolina PB - AlphaMed Company, Inc., dba AlphaMed Press AB - Objectives. Guidelines recommend gene-expression profiling (GEP) tests to identify early-stage breast cancer patients who may benefit from chemotherapy. However, variation exists in oncologists' use of GEP. We explored medical oncologists' views of GEP tests and factors impacting its use in clinical practice. Methods. We used a qualitative design, comprising telephone interviews with medical oncologists (n = 14; 10 academic, 4 in the community) recruited through oncology clinics, professional advertisements, and referrals. Interviews were analyzed for anticipated and emergent themes using the constant comparative method including searches for disconfirming evidence. Results. Some oncologists considered GEP to be a tool that enhanced confidence in their established approach to risk assessments, whereas others described it as 'critical' to resolving their uncertainty about whether to recommend chemotherapy. Some community oncologists also valued the test in interpreting what they considered variable practice and accuracy across pathology reports and testing facilities. However, concerns were also raised about GEP's cost, overuse, inappropriate use, and over-reliance on the results within the medical community. In addition, although many oncologists said it was simple to explain the test to patients, paradoxically, they remained uncertain about patients' understanding of the test results and their treatment implications. Conclusion. Oncologists valued the test as a treatment-decision support tool despite their concerns about its cost, over-reliance, overuse, and inappropriate use by other oncologists, as well as patients' limited understanding of GEP. The results identify a need for decision aids to support patients' understanding and clinical practice guidelines to facilitate standardized use of the test. SN - 1083-7159 AD - Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada AD - Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre,Toronto, Ontario, Canada AD - Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Toronto, Ontario, Canada AD - DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada AD - Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada U2 - PMID: 25746345. DO - 10.1634/theoncologist.2014-0268 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103795922&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 103765714 T1 - Treatment Selection for Patients with Ductal Carcinoma In Situ ( DCIS) of the Breast Using the University of Southern California/Van Nuys ( USC/ VNPI) Prognostic Index. AU - Silverstein, Melvin J. AU - Lagios, Michael D. Y1 - 2015/03//Mar/Apr2015 N1 - Accession Number: 103765714. Language: English. Entry Date: 20150309. Revision Date: 20160229. Publication Type: Journal Article; algorithm; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Peer Reviewed; USA. Special Interest: Oncologic Care; Women's Health. NLM UID: 9505539. KW - Carcinoma, Ductal, Breast -- Therapy KW - Carcinoma in Situ -- Therapy KW - Decision Making KW - Human KW - Academic Medical Centers KW - California KW - Patient Selection KW - Algorithms KW - Treatment Outcomes KW - Prospective Studies KW - Neoplasm Staging KW - Kaplan-Meier Estimator SP - 127 EP - 132 JO - Breast Journal JF - Breast Journal JA - BREAST J VL - 21 IS - 2 CY - Malden, Massachusetts PB - Wiley-Blackwell AB - The University of Southern California/Van Nuys Prognostic Index ( USC/ VNPI) is an algorithm that quantifies five measurable prognostic factors known to be important in predicting local recurrence in conservatively treated patients with ductal carcinoma in situ ( DCIS) (tumor size, margin width, nuclear grade, age, and comedonecrosis). With five times as many patients since originally developed, sufficient numbers now exist for analysis by individual scores rather than groups of scores. To achieve a local recurrence rate of less than 20% at 12 years, these data support excision alone for all patients scoring 4, 5, or 6 and patients who score 7 but have margin widths ≥3 mm. Excision plus RT achieves the less than 20% local recurrence threshold at 12 years for patients who score 7 and have margins <3 mm, patients who score 8 and have margins ≥3 mm, and for patients who score 9 and have margins ≥5 mm. Mastectomy is required for patients who score 8 and have margins <3 mm, who score 9 and have margins <5 mm and for all patients who score 10, 11, or 12 to keep the local recurrence rate less than 20% at 12 years. DCIS is a highly favorable disease. There is no difference in mortality rate regardless of which treatment is chosen. The USC/ VNPI is a numeric tool that can be used to aid the treatment decision-making process. SN - 1075-122X AD - Breast Service, Hoag Memorial Hospital Presbyterian; Keck School of Medicine, University of Southern California AD - Breast Cancer Consultation Service DO - 10.1111/tbj.12368 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103765714&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107782386 T1 - Re: survival outcomes after contralateral prophylactic mastectomy: a decision analysis...J Natl Cancer Inst. 2014 Aug;106(8). pii: dju160. doi: 10.1093/jnci/dju160 AU - Narod, Steven A Y1 - 2015/03// N1 - Accession Number: 107782386. Language: English. Entry Date: 20150417. Revision Date: 20150819. Publication Type: Journal Article; commentary; letter. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Oncologic Care. NLM UID: 7503089. KW - Breast Neoplasms -- Mortality KW - Breast Neoplasms -- Surgery KW - Decision Support Techniques KW - Mastectomy KW - Recurrence -- Prevention and Control KW - Female SP - 1 EP - 1 JO - JNCI: Journal of the National Cancer Institute JF - JNCI: Journal of the National Cancer Institute JA - J NATL CANCER INST VL - 107 IS - 3 PB - Oxford University Press / USA SN - 0027-8874 U2 - PMID: 25713151. DO - jnci/dju507 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107782386&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107782387 T1 - Response...J Natl Cancer Inst. 2014 Aug;106(8). pii: dju160. doi: 10.1093/jnci/dju160; J Natl Cancer Inst. 2015 Mar;107(3). doi: 10.1093/jnci/dju507 AU - Portschy, Pamela R AU - Kuntz, Karen M AU - Tuttle, Todd M Y1 - 2015/03// N1 - Accession Number: 107782387. Language: English. Entry Date: 20150417. Revision Date: 20150819. Publication Type: Journal Article; commentary; letter. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Oncologic Care. NLM UID: 7503089. KW - Breast Neoplasms -- Mortality KW - Breast Neoplasms -- Surgery KW - Decision Support Techniques KW - Mastectomy KW - Recurrence -- Prevention and Control KW - Female SP - 1 EP - 1 JO - JNCI: Journal of the National Cancer Institute JF - JNCI: Journal of the National Cancer Institute JA - J NATL CANCER INST VL - 107 IS - 3 PB - Oxford University Press / USA SN - 0027-8874 U2 - PMID: 25713152. DO - jnci/dju508 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107782387&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 103761668 T1 - When is good enough really good enough? Defining the role of radiation in low-risk ductal carcinoma in situ. AU - Smith, Benjamin D Y1 - 2015/03//3/1/2015 N1 - Accession Number: 103761668. Language: English. Entry Date: 20150515. Revision Date: 20171003. Publication Type: journal article; case study; review. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Oncologic Care. Grant Information: P30 CA016672/CA/NCI NIH HHS/United States. NLM UID: 8309333. KW - Body Mass Index KW - Breast Neoplasms -- Radiotherapy KW - Adenocarcinoma -- Radiotherapy KW - Heart -- Radiation Effects KW - Lumpectomy KW - Obesity -- Complications KW - Radiation Injuries -- Prevention and Control KW - Aged KW - Breast Neoplasms KW - Breast Neoplasms -- Complications KW - Breast Neoplasms -- Pathology KW - Breast Neoplasms -- Surgery KW - Adenocarcinoma KW - Adenocarcinoma -- Complications KW - Adenocarcinoma -- Pathology KW - Adenocarcinoma -- Surgery KW - Decision Trees KW - Disease Management KW - Disease Progression KW - Radiation Dosage KW - Female KW - Patient Satisfaction KW - Radiation Injuries -- Etiology KW - Radiotherapy, Adjuvant -- Adverse Effects KW - Proteins -- Analysis KW - Receptors, Cell Surface -- Analysis KW - Risk Assessment KW - Nomenclature KW - Treatment Outcomes SP - 686 EP - 691 JO - Journal of Clinical Oncology JF - Journal of Clinical Oncology JA - J CLIN ONCOL VL - 33 IS - 7 CY - Alexandria, Virginia PB - American Society of Clinical Oncology SN - 0732-183X AD - The University of Texas MD Anderson Cancer Center, Houston, TX bsmith3@mdanderson.org. U2 - PMID: 25605858. DO - 10.1200/JCO.2014.59.4259 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103761668&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 109722581 T1 - The need for decision and communication aids: a survey of breast cancer survivors. AU - Belkora, Jeffrey K AU - Miller, Melissa F AU - Dougherty, Kasey AU - Gayer, Christopher AU - Golant, Mitch AU - Buzaglo, Joanne S Y1 - 2015/03//2015 Mar N1 - Accession Number: 109722581. Language: English. Entry Date: 20150923. Revision Date: 20150923. Publication Type: Journal Article. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Oncologic Care. NLM UID: 101621609. SP - 104 EP - 112 JO - Journal of Community & Supportive Oncology JF - Journal of Community & Supportive Oncology JA - J COMMUNITY SUPPORT ONCOL VL - 13 IS - 3 CY - Rockville, Maryland PB - Frontline Medical Communications SN - 2330-7749 U2 - PMID: 25880673. DO - 10.12788/jcso.0116 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109722581&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 109783105 T1 - Radiation therapy in the locoregional treatment of triple-negative breast cancer. AU - Moran, Meena S Y1 - 2015/03// N1 - Accession Number: 109783105. Language: English. Entry Date: 20150522. Revision Date: 20150923. Publication Type: Journal Article; review. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care. NLM UID: 100957246. KW - Mastectomy KW - Breast Neoplasms -- Radiotherapy KW - Breast Neoplasms -- Surgery KW - Decision Support Techniques KW - Radiation Dosage KW - Female KW - Disease Susceptibility KW - Neoplasm Recurrence, Local KW - Patient Selection KW - Phenotype KW - Predictive Value of Tests KW - Radiation KW - Radiotherapy, Adjuvant KW - Risk Assessment KW - Risk Factors KW - Treatment Outcomes KW - Breast Neoplasms KW - Breast Neoplasms -- Pathology KW - Tumor Markers, Biological -- Analysis KW - Tumor Markers, Biological SP - e113 EP - 22 JO - Lancet Oncology JF - Lancet Oncology JA - LANCET ONCOL VL - 16 IS - 3 CY - New York, New York PB - Elsevier B.V. AB - This Review assesses the relevant data and controversies regarding the use of radiotherapy for, and locoregional management of, women with triple-negative breast cancer (TNBC). In view of the strong association between BRCA1 and TNBC, knowledge of baseline mutation status can be useful to guide locoregional treatment decisions. TNBC is not a contraindication for breast conservation therapy because data suggest increased locoregional recurrence risks (relative to luminal subtypes) with breast conservation therapy or mastectomy. Although a boost to the tumour bed should routinely be considered after whole breast radiation therapy, TNBC should not be the sole indication for post-mastectomy radiation, and accelerated delivery methods for TNBC should be offered on clinical trials. Preliminary data implying a relative radioresistance for TNBC do not imply radiation omission because radiation provides an absolute locoregional risk reduction. At present, the integration of subtypes in locoregional management decisions is still in its infancy. Until level 1 data supporting treatment decisions based on subtypes are available, standard locoregional management principles should be adhered to. SN - 1470-2045 AD - Yale University School of Medicine, Department of Therapeutic Radiology, New Haven, CT, USA. Electronic address: Meena.Moran@yale.edu. U2 - PMID: 25752562. DO - 10.1016/S1470-2045(14)71104-0 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109783105&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 103761549 T1 - The predictive accuracy of PREDICT: a personalized decision-making tool for Southeast Asian women with breast cancer. AU - Wong, Hoong-Seam AU - Subramaniam, Shridevi AU - Alias, Zarifah AU - Taib, Nur Aishah AU - Ho, Gwo-Fuang AU - Ng, Char-Hong AU - Yip, Cheng-Har AU - Verkooijen, Helena M AU - Hartman, Mikael AU - Bhoo-Pathy, Nirmala Y1 - 2015/02/22/ N1 - Accession Number: 103761549. Language: English. Entry Date: 20150515. Revision Date: 20151031. Publication Type: journal article; research. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 2985248R. KW - Breast Neoplasms -- Mortality KW - Decision Support Techniques KW - Adult KW - Aged KW - Asians -- Statistics and Numerical Data KW - Breast Neoplasms -- Therapy KW - Prospective Studies KW - Female KW - Human KW - Malaysia KW - Middle Age SP - e593 EP - e593 JO - Medicine JF - Medicine JA - MEDICINE VL - 94 IS - 8 CY - Baltimore, Maryland PB - Lippincott Williams & Wilkins AB - Web-based prognostication tools may provide a simple and economically feasible option to aid prognostication and selection of chemotherapy in early breast cancers. We validated PREDICT, a free online breast cancer prognostication and treatment benefit tool, in a resource-limited setting. All 1480 patients who underwent complete surgical treatment for stages I to III breast cancer from 1998 to 2006 were identified from the prospective breast cancer registry of University Malaya Medical Centre, Kuala Lumpur, Malaysia. Calibration was evaluated by comparing the model-predicted overall survival (OS) with patients' actual OS. Model discrimination was tested using receiver-operating characteristic (ROC) analysis. Median age at diagnosis was 50 years. The median tumor size at presentation was 3 cm and 54% of patients had lymph node-negative disease. About 55% of women had estrogen receptor-positive breast cancer. Overall, the model-predicted 5 and 10-year OS was 86.3% and 77.5%, respectively, whereas the observed 5 and 10-year OS was 87.6% (difference: -1.3%) and 74.2% (difference: 3.3%), respectively; P values for goodness-of-fit test were 0.18 and 0.12, respectively. The program was accurate in most subgroups of patients, but significantly overestimated survival in patients aged <40 years, and in those receiving neoadjuvant chemotherapy. PREDICT performed well in terms of discrimination; areas under ROC curve were 0.78 (95% confidence interval [CI]: 0.74-0.81) and 0.73 (95% CI: 0.68-0.78) for 5 and 10-year OS, respectively. Based on its accurate performance in this study, PREDICT may be clinically useful in prognosticating women with breast cancer and personalizing breast cancer treatment in resource-limited settings. SN - 0025-7974 AD - From the National Clinical Research Centre (HSW, SS), Level 3, Dermatology Block, Kuala Lumpur Hospital, Jalan Pahang; Department of Surgery (ZA, NAT, CHN, CHY); Department of Oncology (GFH), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Imaging Division (HMV), University Medical Center Utrecht, Utrecht, The Netherlands; Saw Swee Hock School of Public Health (HMV, MH), National University of Singapore; Department of Surgery (MH), Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore; Julius Centre University of Malaya (NBP), Centre for Clinical Epidemiology and Evidence-Based Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; and Julius Center for Health Sciences and Primary Care (NBP), University Medical Center Utrecht, Utrecht, The Netherlands. U2 - PMID: 25715267. DO - 10.1097/MD.0000000000000593 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103761549&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 109700208 T1 - Cost-effectiveness of trastuzumab in metastatic breast cancer: mainly a matter of price in the EU? AU - Garattini, Livio AU - van de Vooren, Katelijne AU - Curto, Alessandro Y1 - 2015/02// N1 - Accession Number: 109700208. Language: English. Entry Date: 20150923. Revision Date: 20170104. Publication Type: journal article. Journal Subset: Continental Europe; Double Blind Peer Reviewed; Europe; Health Services Administration; Peer Reviewed. NLM UID: 8409431. SP - 212 EP - 216 JO - Health Policy JF - Health Policy JA - HEALTH POLICY VL - 119 IS - 2 PB - Elsevier B.V. AB - Trastuzumab (TR), a monoclonal antibody approved by EMA in 2000 and one of the first examples of "targeted therapy", is indicated to treat human epidermal growth factor receptor 2 (HER2) positive breast cancer. TR, whose patent will expire in 2015 in Europe, has been judged positively for reimbursement by most public authorities in the EU. Here we critically review the existing evidence on TR in metastatic breast cancer (MBC), in line with the multidisciplinary health technology assessment (HTA) approach, to assess whether the existing evidence supports TR positive reimbursement decisions taken in MBC by EU health authorities. We did a literature search for the main HTA topics (efficacy, quality of life and ethics) on the PubMed international database (2000-2013). Then, we did a specific literature search to select the full economic evaluations (FEEs) conducted in EU countries focused on TR as first-line innovative therapy in MBC. We retrieved scant evidence in the literature to support TR reimbursement in MBC. We found only two clinical trials and their results were unclear because of the large proportion of patients who crossed over. Moreover, the quality of methods was poor in all four European FEEs selected. This example of HTA exercise on a mature monoclonal antibody in a specific indication casts doubts on how often the reimbursement decisions taken by EU health authorities in emotional pathologies like cancer are rational. These decisions should at least be reconsidered periodically on the basis of the latest evidence. SN - 0168-8510 U2 - PMID: 25523144. DO - 10.1016/j.healthpol.2014.12.002 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109700208&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 109696164 T1 - Cost-effectiveness analysis of prognostic gene expression signature-based stratification of early breast cancer patients. AU - Blank, Patricia R AU - Filipits, Martin AU - Dubsky, Peter AU - Gutzwiller, Florian AU - Lux, Michael P AU - Brase, Jan C AU - Weber, Karsten E AU - Rudas, Margaretha AU - Greil, Richard AU - Loibl, Sibylle AU - Szucs, Thomas D AU - Kronenwett, Ralf AU - Schwenkglenks, Matthias AU - Gnant, Michael Y1 - 2015/02// N1 - Accession Number: 109696164. Language: English. Entry Date: 20150923. Revision Date: 20160131. Publication Type: journal article. Journal Subset: Australia & New Zealand; Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed. NLM UID: 9212404. SP - 179 EP - 190 JO - PharmacoEconomics JF - PharmacoEconomics JA - PHARMACOECONOMICS VL - 33 IS - 2 PB - Springer Science & Business Media B.V. AB - Background: The individual risk of recurrence in hormone receptor-positive primary breast cancer patients determines whether adjuvant endocrine therapy should be combined with chemotherapy. Clinicopathological parameters and molecular tests such as EndoPredict(®) (EPclin) can support decision making in patients with estrogen receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative cancer.Objective: Using a life-long Markov state transition model, we determined the health economic impact and incremental cost effectiveness of EPclin-based risk stratification in combination with clinical guidelines [German-S3, National Comprehensive Cancer Center Network (NCCN), and St. Gallen] to decide on chemotherapy use.Methods: Information on overall and metastasis-free survival came from Austrian Breast & Colorectal Cancer Study Group clinical trials 6/8 (n = 1,619) and published literature. Effectiveness was assessed as quality-adjusted life-years (QALYs). Costs (2010) were assessed from a German third-party payer perspective.Results: Lifetime costs per patient ranged from 28,268 (St.Gallen and EPclin) to 33,756 (NCCN). Due to an imperfect prognostic value and differences in chemotherapy use, strategies achieved between 13.165 QALYs (NCCN) and 13.173 QALYs (EPclin alone) per patient. Using German-S3 as reference, three strategies showed dominant results (St. Gallen and EPclin, German-S3 and EPclin, EPclin alone). Compared to German-S3, the addition of EPclin saved 3,388 and gained 0.002 QALYs per patient. Combining guidelines with EPclin remained preferable in sensitivity analysis.Conclusion: Our study suggests that molecular markers can be sensibly combined with clinical guidelines to determine the risk profile of adjuvant breast cancer patients. Compared with the current German best practice (German-S3), combinations of EPclin with the St. Gallen, German-S3 or NCCN guideline and EPclin alone were dominant from the perspective of the German healthcare system. SN - 1170-7690 U2 - PMID: 25404424. DO - 10.1007/s40273-014-0227-x UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109696164&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 109746088 T1 - Understanding older women's decision making and coping in the context of breast cancer treatment. AU - Lifford, Kate J AU - Witt, Jana AU - Burton, Maria AU - Collins, Karen AU - Caldon, Lisa AU - Edwards, Adrian AU - Reed, Malcolm AU - Wyld, Lynda AU - Brain, Kate Y1 - 2015/01// N1 - Accession Number: 109746088. Language: English. Entry Date: 20150923. Revision Date: 20170929. Publication Type: journal article; research. Journal Subset: Biomedical; Computer/Information Science; Europe; UK & Ireland. Special Interest: Informatics. Grant Information: RP-PG-1209-10071//Department of Health/United Kingdom. NLM UID: 101088682. SP - 45 EP - 45 JO - BMC Medical Informatics & Decision Making JF - BMC Medical Informatics & Decision Making JA - BMC MED INFORM DECIS MAKING VL - 15 IS - 1 PB - BioMed Central AB - Background: Primary endocrine therapy (PET) is a recognised alternative to surgery followed by endocrine therapy for a subset of older, frailer women with breast cancer. Choice of treatment is preference-sensitive and may require decision support. Older patients are often conceptualised as passive decision-makers. The present study used the Coping in Deliberation (CODE) framework to gain insight into decision making and coping processes in a group of older women who have faced breast cancer treatment decisions, and to inform the development of a decision support intervention (DSI).Methods: Semi-structured interviews were carried out with older women who had been offered a choice of PET or surgery from five UK hospital clinics. Women's information and support needs, their breast cancer diagnosis and treatment decisions were explored. A secondary analysis of these interviews was conducted using the CODE framework to examine women's appraisals of health threat and coping throughout the deliberation process.Results: Interviews with 35 women aged 75-98 years were analysed. Appraisals of breast cancer and treatment options were sometimes only partial, with most women forming a preference for treatment relatively quickly. However, a number of considerations which women made throughout the deliberation process were identified, including: past experiences of cancer and its treatment; scope for choice; risks, benefits and consequences of treatment; instincts about treatment choice; and healthcare professionals' recommendations. Women also described various strategies to cope with breast cancer and their treatment decisions. These included seeking information, obtaining practical and emotional support from healthcare professionals, friends and relatives, and relying on personal faith. Based on these findings, key questions were identified that women may ask during deliberation.Conclusions: Many older women with breast cancer may be considered involved rather than passive decision-makers, and may benefit from DSIs designed to support decision making and coping within and beyond the clinic setting. SN - 1472-6947 U2 - PMID: 26058557. DO - 10.1186/s12911-015-0167-1 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109746088&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 103872497 T1 - Using Big Data to Track Trends in Medical Practice...Hershmann DL, Neugut AI, Shim JJ, et al: Erythropoiesis stimulating agent use after changes in Medicare reimbursement policy. J Oncol Pract. doi:10.1200/ JOP.2013.001255 AU - Kolacevski, Andrej AU - Mann, Joshua T. AU - Hauser, Robert AU - Schilsky, Richard L. Y1 - 2015/01// N1 - Accession Number: 103872497. Language: English. Entry Date: 20150116. Revision Date: 20150710. Publication Type: Journal Article; commentary; letter; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; USA. Special Interest: Oncologic Care. NLM UID: 101261852. KW - Data Analytics -- Methods KW - Breast Neoplasms -- Drug Therapy KW - Chemotherapy, Cancer -- Trends -- United States KW - Billing and Claims -- Utilization KW - Medicare KW - United States KW - Insurance, Health, Reimbursement KW - Data Analysis, Statistical KW - American Society of Clinical Oncology KW - Human KW - Public Policy SP - 69 EP - 70 JO - Journal of Oncology Practice JF - Journal of Oncology Practice JA - J ONCOL PRACT VL - 11 IS - 1 CY - Alexandria, Virginia PB - American Society of Clinical Oncology SN - 1554-7477 AD - American Society of Clinical Oncology DO - 10.1200/JOP.2014.001541 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103872497&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 103874939 T1 - Recursive partitioning analysis of lymph node ratio in breast cancer patients. AU - Chang, Yao-Jen AU - Chung, Kuo-Piao AU - Chen, Li-Ju AU - Chang, Yun-Jau Y1 - 2015/01// N1 - Accession Number: 103874939. Language: English. Entry Date: 20150501. Revision Date: 20151031. Publication Type: journal article. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 2985248R. KW - Breast Neoplasms -- Pathology KW - Carcinoma, Ductal, Breast -- Pathology KW - Lymph Nodes -- Pathology KW - Adult KW - Aged KW - Aged, 80 and Over KW - Artificial Intelligence KW - Breast Neoplasms -- Mortality KW - Carcinoma, Ductal, Breast -- Mortality KW - Decision Trees KW - Female KW - Middle Age KW - Prognosis KW - Risk Assessment KW - Taiwan SP - e208 EP - e208 JO - Medicine JF - Medicine JA - MEDICINE VL - 94 IS - 1 CY - Baltimore, Maryland PB - Lippincott Williams & Wilkins AB - Lymph node ratio (LNR) is a powerful prognostic factor for breast cancer. We conducted a recursive partitioning analysis (RPA) of the LNR to identify the prognostic risk groups in breast cancer patients. Records of newly diagnosed breast cancer patients between 2002 and 2006 were searched in the Taiwan Cancer Database. The end of follow-up was December 31, 2009. We excluded patients with distant metastases, inflammatory breast cancer, survival <1 month, no mastectomy, or missing lymph node status. Primary outcome was 5-year overall survival (OS). For univariate significant predictors, RPA were used to determine the risk groups. Among the 11,349 eligible patients, we identified 4 prognostic factors (including LNR) for survival, resulting in 8 terminal nodes. The LNR cutoffs were 0.038, 0.259, and 0.738, which divided LNR into 4 categories: very low (LNR ≤ 0.038), low (0.038 < LNR ≤ 0.259), moderate (0.259 < LNR ≤ 0.738), and high (0.738 < LNR). Then, 4 risk groups were determined as follows: Class 1 (very low risk, 8,265 patients), Class 2 (low risk, 1,901 patients), Class 3 (moderate risk, 274 patients), and Class 4 (high risk, 900 patients). The 5-year OS for Class 1, 2, 3, and 4 were 93.2%, 83.1%, 72.3%, and 56.9%, respectively (P< 0.001). The hazard ratio of death was 2.70, 4.52, and 8.59 (95% confidence interval 2.32-3.13, 3.49-5.86, and 7.48-9.88, respectively) times for Class 2, 3, and 4 compared with Class 1 (P < 0.001). In conclusion, we identified the optimal cutoff LNR values based on RPA and determined the related risk groups, which successfully predict 5-year OS in breast cancer patients. SN - 0025-7974 AD - From the Department of Surgery (Yao-Jen Chang), Taipei Branch, Buddhist Tzu Chi General Hospital; Graduate Institute of Health Policy and Management (K-PC, L-JC), College of Public Health, National Taiwan University; Department of Ophthalmology (L-JC), HepingFuyou Branch; Department of General Surgery (Yun-Jau Chang), Zhong-Xing Branch, Taipei City Hospital; and Department of General Surgery (Yun-Jau Chang), National Taiwan University Hospital, Taipei, Taiwan. U2 - PMID: 25569639. DO - 10.1097/MD.0000000000000208 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103874939&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 109691300 T1 - Pertuzumab in combination with trastuzumab and docetaxel for the treatment of HER2-positive metastatic or locally recurrent unresectable breast cancer. AU - Fleeman, Nigel AU - Bagust, Adrian AU - Beale, Sophie AU - Dwan, Kerry AU - Dickson, Rumona AU - Proudlove, Chris AU - Dundar, Yenal Y1 - 2015/01// N1 - Accession Number: 109691300. Language: English. Entry Date: 20150923. Revision Date: 20171117. Publication Type: journal article; review. Journal Subset: Australia & New Zealand; Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed. NLM UID: 9212404. SP - 13 EP - 23 JO - PharmacoEconomics JF - PharmacoEconomics JA - PHARMACOECONOMICS VL - 33 IS - 1 PB - Springer Science & Business Media B.V. AB - The National Institute for Health and Care Excellence (NICE) invited the manufacturer of pertuzumab (Roche) to submit evidence for the clinical and cost effectiveness of pertuzumab + trastuzumab + docetaxel for the treatment of human epidermal growth factor receptor 2-positive (HER2+) metastatic or locally recurrent unresectable breast cancer in accordance with the Institute's Single Technology Appraisal (STA) process. The Liverpool Reviews and Implementation Group (LRiG) at the University of Liverpool was commissioned to act as the Evidence Review Group (ERG). This article summarises the ERG's review of the evidence submitted by the manufacturer and provides a summary of the Appraisal Committee's (AC) initial decision. At the time of writing, final guidance had not been published by NICE. The clinical evidence was mainly derived from an ongoing phase III randomised double-blind placebo-controlled international multicentre clinical trial (CLEOPATRA), designed to evaluate efficacy and safety in 808 patients, which compared pertuzumab + trastuzumab + docetaxel (pertuzumab arm) with placebo + trastuzumab + docetaxel (control arm). Both progression-free survival (PFS) and overall survival (OS) were analysed at two data cut-off points-May 2011 (median follow-up of 18 months) and May 2012 (median follow-up of 30 months). At both time points, PFS was significantly longer in the pertuzumab arm (18.5 months compared with 12.4 months in the control arm at the first data cut-off point and 18.7 versus 12.4 months at the second data cut-off point). Assessment of OS benefit suggested an improvement for patients in the pertuzumab arm with a strong trend towards an OS benefit at the second data cut-off point; however, due to the immaturity of the OS data, the magnitude of the OS benefit was uncertain. Importantly, cardiotoxicity was not increased in patients treated with a combination of pertuzumab + trastuzumab + docetaxel. The ERG's main concern with the clinical effectiveness data was the lack of mature OS data. An additional concern of the AC was that the majority of patients in the randomised controlled trial were trastuzumab naïve, which does not reflect current clinical practice. The incremental cost-effectiveness ratios (ICERs) generated by the manufacturer's model are considered to be commercial in confidence data and therefore cannot be published. Nevertheless, the results of the manufacturer's probabilistic sensitivity analyses suggest that pertuzumab + trastuzumab + docetaxel has a 0 % probability of being cost effective at a willingness-to-pay of £30,000 per quality-adjusted life-year gained when compared with trastuzumab + docetaxel. The ERG believes that more realistic estimates of the ICERs are considerably higher, almost double those presented by the manufacturer. This is because the ERG believes that due to the manner in which the economic model is constructed, the additional survival benefit following disease progression that is generated for patients treated with pemetrexed + trastuzumab + docetaxel is unrealistic. At the time of writing, NICE had not made a final decision regarding this technology but had instead referred the issue of the assessment of technologies that are not effective at a zero price to their Decision Support Unit for advice. SN - 1170-7690 U2 - PMID: 25138171. DO - 10.1007/s40273-014-0206-2 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109691300&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 103879314 T1 - Impact of Prophylactic Mastectomy in BRCA1/2 Mutation Carriers. AU - Rhiem, Kerstin AU - Schmutzler, Rita Y1 - 2014/12// N1 - Accession Number: 103879314. Language: English. Entry Date: 20150123. Revision Date: 20150710. Publication Type: Journal Article. Journal Subset: Biomedical; Blind Peer Reviewed; Continental Europe; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed. Special Interest: Oncologic Care. NLM UID: 101254060. KW - Mastectomy KW - Breast Neoplasms -- Familial and Genetic KW - Genes, BRCA KW - Heterozygote KW - Decision Making, Patient KW - Genetic Screening KW - Genotype KW - Phenotype SP - 385 EP - 389 JO - Breast Care JF - Breast Care JA - BREAST CARE VL - 9 IS - 6 PB - Karger AG AB - Unlike the general decrease in invasive oncologic care, the trend for prophylactic bilateral mastectomy in healthy women and prophylactic contralateral mastectomy in women with unilateral breast cancer is steadily rising. This is even more surprising when considering that for e.g. prophylactic contralateral mastectomy no clear survival benefit has been demonstrated so far. The decision-making process around risk-reducing surgery may be influenced by several conflicting parameters such as the patient's fears and desire to achieve a survival advantage, the surgeon's financial motivations, or the oncologist's paternalistic approach to the above trend. Physicians should support their patients throughout the decision-making process, guide them through the dense fog of information, and encourage them to reconsider all options and alternatives before embarking on an irreversible surgical intervention. Healthy and diseased women should be comprehensively informed about their absolute individual risks for cancer, the benefits and harms of the surgery, alternative preventive strategies, and last but not least the competing risks of preceding carcinomas and cancer in general. Within the framework of non-directive counseling in the specialized centers of the German Consortium for Hereditary Breast and Ovarian Cancer (GC-HBOC), decision-making aids are being developed with grants from the Federal Ministry of Health and the German Cancer Aid to support women in making conclusive and satisfactory decisions. © 2014 S. Karger AG, Freiburg SN - 1661-3791 AD - Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Germany U2 - PMID: 25759620. DO - 10.1159/000369592 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103879314&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 109763449 T1 - Genomic profile of breast cancer: cost-effectiveness analysis from the Spanish National Healthcare System perspective. AU - Seguí, Miguel Angel AU - Crespo, Carlos AU - Cortés, Javier AU - Lluch, Ana AU - Brosa, Max AU - Becerra, Virginia AU - Chiavenna, Sebastián Matias AU - Gracia, Alfredo Y1 - 2014/12// N1 - Accession Number: 109763449. Language: English. Entry Date: 20150821. Revision Date: 20150923. Publication Type: Journal Article; research. Commentary: Seguí Miguel Angel, Crespo Carlos, Cortés Javier, Lluch Ana, Brosa Max, Becerra Virginia, et al. In response: Genomic profile of breast cancer. (EXPERT REV PHARMACOECON OUTCOMES RES) Jun2015; 15 (3): 395-397. Journal Subset: Biomedical; Europe; UK & Ireland. Special Interest: Evidence-Based Practice. NLM UID: 101132257. KW - Breast Neoplasms -- Economics KW - Breast Neoplasms KW - Gene Expression Profiling -- Economics KW - Genetic Screening -- Economics KW - Health Care Costs KW - Individualized Medicine -- Economics KW - National Health Programs -- Economics KW - Tumor Markers, Biological KW - Algorithms KW - Antineoplastic Agents -- Economics KW - Antineoplastic Agents -- Therapeutic Use KW - Breast Neoplasms -- Drug Therapy KW - Chemotherapy, Adjuvant -- Economics KW - Cost Benefit Analysis KW - Decision Support Techniques KW - Female KW - Disease Susceptibility KW - Genetic Screening -- Methods KW - Human KW - Probability KW - Middle Age KW - Models, Statistical KW - Neoplasm Recurrence, Local KW - Phenotype KW - Predictive Value of Tests KW - Quality of Life KW - Quality-Adjusted Life Years KW - Risk Assessment KW - Risk Factors KW - Spain KW - Time Factors KW - Treatment Outcomes SP - 889 EP - 899 JO - Expert Review of Pharmacoeconomics & Outcomes Research JF - Expert Review of Pharmacoeconomics & Outcomes Research JA - EXPERT REV PHARMACOECON OUTCOMES RES VL - 14 IS - 6 CY - Philadelphia, Pennsylvania PB - Taylor & Francis Ltd SN - 1473-7167 U2 - PMID: 25213317. DO - 10.1586/14737167.2014.957185 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109763449&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 109763441 T1 - The association of chemotherapy versus hormonal therapy and health outcomes among patients with hormone receptor-positive, HER2-negative metastatic breast cancer: experience from the patient perspective. AU - Gupta, Shaloo AU - Zhang, Jie AU - Jerusalem, Guy Y1 - 2014/12// N1 - Accession Number: 109763441. Language: English. Entry Date: 20150821. Revision Date: 20150923. Publication Type: Journal Article; research. Journal Subset: Biomedical; Europe; UK & Ireland. Special Interest: Evidence-Based Practice. NLM UID: 101132257. KW - Antineoplastic Agents, Combined -- Therapeutic Use KW - Antineoplastic Agents, Hormonal -- Therapeutic Use KW - Breast Neoplasms -- Drug Therapy KW - Patient Satisfaction KW - Proteins -- Drug Effects KW - Receptors, Cell Surface -- Deficiency KW - Receptors, Cell Surface -- Drug Effects KW - Antineoplastic Agents, Combined -- Adverse Effects KW - Antineoplastic Agents, Hormonal -- Adverse Effects KW - Breast Neoplasms -- Metabolism KW - Breast Neoplasms -- Pathology KW - Chi Square Test KW - Cross Sectional Studies KW - Decision Support Techniques KW - Economic Aspects of Illness KW - Europe KW - Female KW - Human KW - Linear Regression KW - Middle Age KW - Multivariate Analysis KW - Neoplasm Metastasis KW - Patient Selection KW - Proteins -- Metabolism KW - Quality of Life KW - Questionnaires KW - Receptors, Cell Surface -- Metabolism KW - Risk Assessment KW - Risk Factors KW - Socioeconomic Factors KW - Surveys KW - Time Factors KW - Treatment Outcomes KW - United States SP - 929 EP - 940 JO - Expert Review of Pharmacoeconomics & Outcomes Research JF - Expert Review of Pharmacoeconomics & Outcomes Research JA - EXPERT REV PHARMACOECON OUTCOMES RES VL - 14 IS - 6 CY - Philadelphia, Pennsylvania PB - Taylor & Francis Ltd SN - 1473-7167 U2 - PMID: 25130198. DO - 10.1586/14737167.2014.949243 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109763441&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 99104087 T1 - Meta-Analysis of Decision Impact and Net Decision Change in Adjuvant Chemotherapy Allocation in Early Stage Node-Negative, Estrogen Receptor-Positive Breast Cancer with a 21-Gene Assay. AU - Augustovski, F. AU - Soto, N. AU - Caporale, J. AU - Gonzalez, L. AU - Gibbons, L. AU - Ciapponi, A. Y1 - 2014/11// N1 - Accession Number: 99104087. Language: English. Entry Date: In Process. Revision Date: 20160708. Publication Type: journal article. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 100883818. SP - A662 EP - A662 JO - Value in Health JF - Value in Health JA - VALUE HEALTH VL - 17 IS - 7 CY - New York, New York PB - Elsevier B.V. SN - 1098-3015 AD - Economic Evaluations & HTA Department; Institute for Clinical Effectiveness and Health Policy (IECS) and Professor of Public Health, University of Buenos Aires, Buenos Aires, Argentina AD - Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina U2 - PMID: 27202411. DO - 10.1016/j.jval.2014.08.2432 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=99104087&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 103882417 T1 - Development of a prediction model for lymph node metastasis in luminal A subtype breast cancer: The possibility to omit sentinel lymph node biopsy. AU - Nakauchi, Chiaki AU - Naoi, Yasuto AU - Shimazu, Kenzo AU - Tsunashima, Ryo AU - Nishio, Minako AU - Maruyama, Naomi AU - Shimomura, Atsushi AU - Kagara, Naofumi AU - Shimoda, Masashi AU - Kim, Seung Jin AU - Noguchi, Shinzaburo Y1 - 2014/10/10/ N1 - Accession Number: 103882417. Language: English. Entry Date: 20141114. Revision Date: 20150710. Publication Type: Journal Article; research. Journal Subset: Biomedical; Europe; UK & Ireland. Special Interest: Oncologic Care. NLM UID: 7600053. KW - Breast Neoplasms KW - Decision Support Techniques KW - Gene Expression Profiling -- Methods KW - Genetic Screening -- Methods KW - Oligonucleotide Array Sequence Analysis KW - Sentinel Lymph Node Biopsy KW - Tumor Markers, Biological KW - Breast Neoplasms -- Classification KW - Breast Neoplasms -- Mortality KW - Breast Neoplasms -- Surgery KW - Prognosis KW - Female KW - Genes KW - Disease Susceptibility KW - Human KW - Kaplan-Meier Estimator KW - Neoplasm Metastasis KW - Middle Age KW - Multivariate Analysis KW - Models, Statistical KW - Phenotype KW - Predictive Value of Tests KW - Reproducibility of Results KW - Risk Assessment KW - Risk Factors KW - Treatment Outcomes KW - Unnecessary Procedures SP - 52 EP - 58 JO - Cancer Letters JF - Cancer Letters JA - CANCER LETT VL - 353 IS - 1 PB - Elsevier B.V. SN - 0304-3835 AD - Department of Breast and Endocrine Surgery, Osaka University, Graduate School of Medicine, Osaka, Japan. AD - Department of Breast and Endocrine Surgery, Osaka University, Graduate School of Medicine, Osaka, Japan. Electronic address: noguchi@onsurg.med.osaka-u.ac.jp. U2 - PMID: 25016059. DO - 10.1016/j.canlet.2014.07.003 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103882417&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 103883191 T1 - A highly-sensitive anti-Müllerian hormone assay improves analysis of ovarian function following chemotherapy for early breast cancer. AU - Chai, Joyce AU - Howie, A. Forbes AU - Cameron, David A. AU - Anderson, Richard A. Y1 - 2014/09/15/ N1 - Accession Number: 103883191. Language: English. Entry Date: 20140908. Revision Date: 20150710. Publication Type: Journal Article; research. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care; Women's Health. NLM UID: 9005373. KW - Biological Markers -- Analysis KW - Breast Neoplasms -- Drug Therapy KW - Chemotherapy, Cancer KW - Ovary -- Physiology KW - Human KW - Female KW - Prospective Studies KW - Descriptive Statistics KW - P-Value SP - 2367 EP - 2374 JO - European Journal of Cancer JF - European Journal of Cancer JA - EUR J CANCER VL - 50 IS - 14 PB - Pergamon Press - An Imprint of Elsevier Science AB - Aim Anti-Müllerian hormone (AMH) shows promise as a biomarker of the ovarian reserve but current assays are insufficiently sensitive to allow assessment of this post-chemotherapy in most women. We have assessed a new highly sensitive AMH assay (Ansh picoAMH) in the evaluation of ovarian activity in women with very low ovarian reserve after chemotherapy. Methods A prospective cohort and an independent validation cohort of premenopausal women with early breast cancer (eBC) were recruited at the time of diagnosis (combined n = 98), and ovarian reserve markers 2–5 years later following chemotherapy were assessed in relation to menstrual activity. Results The picoAMH assay had a limit of detection of 7.5 pg/ml. AMH clearly distinguished women with ongoing menses from those with amenorrhoea at 2 years after diagnosis (mean 522 ± 169 versus 8.9 ± 1.3 pg/ml, P < 0.0001) with high predictive value for continuing menses or amenorrhoea for the subsequent 3 years. AMH was detectable in more women than using a previous assay ( P = 0.004). Other markers of the ovarian reserve (follicle-stimulating hormone (FSH), inhibin B) were also of discriminatory value but to lesser extents. This finding was validated in a second, independent cohort of women treated for eBC. Conclusion The 10-fold increased assay sensitivity showed very clear distinction between groups based on ovarian activity with excellent prediction of future menses or amenorrhoea. This will improve assessment of post-chemotherapy ovarian function in women and may aid treatment decisions. SN - 0959-8049 AD - MRC Centre for Reproductive Health, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK AD - Edinburgh Breast Unit and Edinburgh University Cancer Research Centre, Western General Hospital, Edinburgh, UK DO - 10.1016/j.ejca.2014.06.011 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103883191&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 103893636 T1 - How big is big enough? Thinking about contralateral prophylactic mastectomy. AU - Pauker, Stephen G AU - Alseiari, Mohamed Y1 - 2014/08/12/ N1 - Accession Number: 103893636. Language: English. Entry Date: 20140926. Revision Date: 20150812. Publication Type: Journal Article; editorial. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Oncologic Care. NLM UID: 7503089. KW - Breast Neoplasms -- Mortality KW - Breast Neoplasms -- Surgery KW - Decision Support Techniques KW - Mastectomy KW - Neoplasm Recurrence, Local -- Prevention and Control KW - Female SP - 1 EP - 1 JO - JNCI: Journal of the National Cancer Institute JF - JNCI: Journal of the National Cancer Institute JA - J NATL CANCER INST VL - 106 IS - 8 PB - Oxford University Press / USA SN - 0027-8874 AD - Affiliation of authors: Division of Clinical Decision Making, Department of Medicine, Tufts Medical Center, Boston, MA. U2 - PMID: 25031309. DO - jnci/dju175 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103893636&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 103893637 T1 - Survival outcomes after contralateral prophylactic mastectomy: a decision analysis. AU - Portschy, Pamela R AU - Kuntz, Karen M AU - Tuttle, Todd M Y1 - 2014/08/12/ N1 - Accession Number: 103893637. Language: English. Entry Date: 20140926. Revision Date: 20150812. Publication Type: Journal Article; research. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Oncologic Care. NLM UID: 7503089. KW - Breast Neoplasms -- Mortality KW - Breast Neoplasms -- Surgery KW - Decision Support Techniques KW - Mastectomy -- Methods KW - Neoplasm Recurrence, Local -- Prevention and Control KW - Adult KW - Breast Neoplasms -- Pathology KW - Female KW - Human KW - Life Expectancy KW - Middle Age KW - Neoplasm Staging KW - Predictive Value of Tests KW - Probability KW - Prognosis KW - United States SP - 1 EP - 1 JO - JNCI: Journal of the National Cancer Institute JF - JNCI: Journal of the National Cancer Institute JA - J NATL CANCER INST VL - 106 IS - 8 PB - Oxford University Press / USA SN - 0027-8874 AD - Affiliations of authors: Department of Surgery (PRP, TMT) and Division of Health Policy and Management (KMK), University of Minnesota, Minneapolis, MN. AD - Affiliations of authors: Department of Surgery (PRP, TMT) and Division of Health Policy and Management (KMK), University of Minnesota, Minneapolis, MN. tuttl006@umn.edu. U2 - PMID: 25031308. DO - jnci/dju160 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103893637&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107860823 T1 - Interinstitutional variation in management decisions for treatment of 4 common types of cancer: A multi-institutional cohort study. AU - Weeks, Jane C AU - Uno, Hajime AU - Taback, Nathan AU - Ting, Gladys AU - Cronin, Angel AU - D'Amico, Thomas A AU - Friedberg, Jonathan W AU - Schrag, Deborah Y1 - 2014/07//7/1/2014 N1 - Accession Number: 107860823. Language: English. Entry Date: 20140829. Revision Date: 20161117. Publication Type: journal article; research. Journal Subset: Biomedical; Expert Peer Reviewed; Peer Reviewed; USA. Grant Information: RC1CA146196/CA/NCI NIH HHS/United States. NLM UID: 0372351. KW - Breast Neoplasms -- Therapy KW - Colorectal Neoplasms -- Therapy KW - Disease Management KW - Lung Neoplasms -- Therapy KW - Lymphoma, Non-Hodgkin's -- Therapy KW - Cancer Care Facilities KW - Prospective Studies KW - Human SP - 20 EP - 30 JO - Annals of Internal Medicine JF - Annals of Internal Medicine JA - ANN INTERN MED VL - 161 IS - 1 CY - Philadelphia, Pennsylvania PB - American College of Physicians AB - Background: When clinical practice is governed by evidence-based guidelines and there is consensus about their validity, practice variation should be minimal. For areas in which evidence gaps exist, greater variation is expected.Objective: To systematically assess interinstitutional variation in management decisions for 4 common types of cancer.Design: Multi-institutional, observational cohort study of patients with cancer diagnosed between July 2006 through May 2011 and observed through 31 December 2011.Setting: 18 cancer centers participating in the formulation of treatment guidelines and systematic outcomes assessment through the National Comprehensive Cancer Network.Patients: 25 589 patients with incident breast cancer, colorectal cancer, lung cancer, or non-Hodgkin lymphoma.Measurements: Interinstitutional variation for 171 binary management decisions with varying levels of supporting evidence. For each decision, variation was characterized by the median absolute deviation of the center-specific proportions.Results: Interinstitutional variation was high (median absolute deviation >10%) for 35 of 171 (20%) oncology management decisions, including 9 of 22 (41%) decisions for non-Hodgkin lymphoma, 16 of 76 (21%) for breast cancer, 7 of 47 (15%) for lung cancer, and 3 of 26 (12%) for colorectal cancer. Forty-six percent of high-variance decisions involved imaging or diagnostic procedures and 37% involved choice of chemotherapy regimen. The evidence grade underpinning the 35 high-variance decisions was category 1 for 0%, 2A for 49%, and 2B/other for 51%.Limitation: Physician identifiers were unavailable, and results may not generalize outside of major cancer centers.Conclusion: The substantial variation in institutional practice manifest among cancer centers reveals a lack of consensus about optimal management for common clinical scenarios. For clinicians, awareness of management decisions with high variation should prompt attention to patient preferences. For health systems, high variation can be used to prioritize comparative effectiveness research, patient-provider education, or pathway development.Primary Funding Source: National Cancer Institute and National Comprehensive Cancer Network. SN - 0003-4819 U2 - PMID: 24979447. DO - 10.7326/M13-2231 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107860823&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 109761505 T1 - Validation of the prognostic gene portfolio, ClinicoMolecular Triad Classification, using an independent prospective breast cancer cohort and external patient populations. AU - Wang, Dong-Yu AU - Done, Susan J AU - Mc Cready, David R AU - Leong, Wey L Y1 - 2014/07// N1 - Accession Number: 109761505. Language: English. Entry Date: 20150923. Revision Date: 20150923. Publication Type: Journal Article; research. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care. NLM UID: 100927353. KW - Breast Neoplasms -- Diagnosis KW - Breast Neoplasms KW - Gene Expression Profiling KW - Genes KW - Adult KW - Aged KW - Breast Neoplasms -- Mortality KW - Cluster Analysis KW - Female KW - Prospective Studies KW - Human KW - Middle Age KW - Neoplasm Grading KW - Neoplasm Metastasis KW - Prognosis KW - Reproducibility of Results KW - Signal Transduction KW - Body Weights and Measures KW - Tumor Markers, Biological SP - R71 EP - R71 JO - Breast Cancer Research JF - Breast Cancer Research JA - BREAST CANCER RES VL - 16 IS - 3 PB - BioMed Central AB - INTRODUCTION: Using genome-wide expression profiles of a prospective training cohort of breast cancer patients, ClinicoMolecular Triad Classification (CMTC) was recently developed to classify breast cancers into three clinically relevant groups to aid treatment decisions. CMTC was found to be both prognostic and predictive in a large external breast cancer cohort in that study. This study serves to validate the reproducibility of CMTC and its prognostic value using independent patient cohorts. METHODS: An independent internal cohort (n = 284) and a new external cohort (n = 2,181) were used to validate the association of CMTC between clinicopathological factors, 12 known gene signatures, two molecular subtype classifiers, and 19 oncogenic signalling pathway activities, and to reproduce the abilities of CMTC to predict clinical outcomes of breast cancer. In addition, we also updated the outcome data of the original training cohort (n = 147). RESULTS: The original training cohort reached a statistically significant difference (p < 0.05) in disease-free survivals between the three CMTC groups after an additional two years of follow-up (median = 55 months). The prognostic value of the triad classification was reproduced in the second independent internal cohort and the new external validation cohort. CMTC achieved even higher prognostic significance when all available patients were analyzed (n = 4,851). Oncogenic pathways Myc, E2F1, Ras and [beta]-catenin were again implicated in the high-risk groups. CONCLUSIONS: Both prospective internal cohorts and the independent external cohorts reproduced the triad classification of CMTC and its prognostic significance. CMTC is an independent prognostic predictor, and it outperformed 12 other known prognostic gene signatures, molecular subtype classifications, and all other standard prognostic clinicopathological factors. Our results support further development of CMTC portfolio into a guide for personalized breast cancer treatments. SN - 1465-5411 U2 - PMID: 24996446. DO - 10.1186/bcr3686 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109761505&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107862189 T1 - Improving decision making about clinical trial participation - a randomised controlled trial of a decision aid for women considering participation in the IBIS-II breast cancer prevention trial. AU - Juraskova, I AU - Butow, P AU - Bonner, C AU - Bell, M L AU - Smith, A B AU - Seccombe, M AU - Boyle, F AU - Reaby, L AU - Cuzick, J AU - Forbes, J F Y1 - 2014/07//2014 Jul 1 N1 - Accession Number: 107862189. Language: English. Entry Date: 20141121. Revision Date: 20150712. Publication Type: Journal Article; research; randomized controlled trial. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care. NLM UID: 0370635. KW - Breast Neoplasms -- Prevention and Control KW - Decision Making KW - Decision Support Techniques KW - Consumer Participation -- Psychosocial Factors KW - Clinical Trials -- Methods KW - Clinical Trials KW - Female KW - Human KW - Middle Age KW - Patient Satisfaction KW - Questionnaires KW - Treatment Outcomes SP - 1 EP - 7 JO - British Journal of Cancer JF - British Journal of Cancer JA - BR J CANCER VL - 111 IS - 1 CY - London, PB - Nature Publishing Group SN - 0007-0920 AD - Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney 2006, Australia. AD - Australia and New Zealand Breast Cancer Trials Group, Australia University of Newcastle, Newcastle 2306, Australia. AD - 1] Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney 2006, Australia [2] Australia and New Zealand Breast Cancer Trials Group, Australia University of Newcastle, Newcastle 2306, Australia [3] Pam McLean Centre, The University of Sydney, Sydney 2006, Australia. AD - Cancer Research UK, Department of Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine, Queen Mary College, University of London, London E1 4NS, UK. U2 - PMID: 24892447. DO - 10.1038/bjc.2014.144 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107862189&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 103832253 T1 - BRECONDA: Development and acceptability of an interactive decisional support tool for women considering breast reconstruction. AU - Sherman, Kerry A AU - Harcourt, Diana M AU - Lam, Thomas C AU - Shaw, Laura-Kate AU - Boyages, John Y1 - 2014/07// N1 - Accession Number: 103832253. Language: English. Entry Date: 20150313. Revision Date: 20150710. Publication Type: Journal Article. Journal Subset: Biomedical; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care; Psychiatry/Psychology. NLM UID: 9214524. KW - Decision Support Techniques KW - Breast Reconstruction KW - Adult KW - Australia KW - Breast Neoplasms -- Psychosocial Factors KW - Breast Neoplasms -- Surgery KW - Adenocarcinoma -- Psychosocial Factors KW - Adenocarcinoma -- Surgery KW - Decision Making KW - Female KW - Middle Age KW - Patient Attitudes KW - Consumer Participation SP - 835 EP - 838 JO - Psycho-Oncology JF - Psycho-Oncology JA - PSYCHO ONCOL VL - 23 IS - 7 CY - Hoboken, New Jersey PB - John Wiley & Sons, Inc. SN - 1057-9249 AD - Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia; Westmead Breast Cancer Institute, Westmead Hospital, University of Sydney, Sydney, Australia. U2 - PMID: 24991748. DO - 10.1002/pon.3498 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103832253&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107793438 T1 - Prospective study of the effect of the 21-gene assay on adjuvant clinical decision-making in Japanese women with estrogen receptor-positive, node-negative, and node-positive breast cancer. AU - Yamauchi, Hideko AU - Nakagawa, Chizuko AU - Takei, Hiroyuki AU - Chao, Calvin AU - Yoshizawa, Carl AU - Yagata, Hiroshi AU - Yoshida, Atsushi AU - Hayashi, Naoki AU - Hell, Susanne AU - Nakamura, Seigo Y1 - 2014/06// N1 - Accession Number: 107793438. Language: English. Entry Date: 20150206. Revision Date: 20150712. Publication Type: Journal Article; research. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Oncologic Care. NLM UID: 100898731. KW - Breast Neoplasms -- Drug Therapy KW - Breast Neoplasms KW - Breast Neoplasms -- Pathology KW - Decision Support Techniques KW - Gene Expression Profiling KW - Adult KW - Aged KW - Asians KW - Chemotherapy, Adjuvant KW - Decision Making KW - Female KW - Human KW - Neoplasm Metastasis KW - Middle Age KW - Proteins SP - 191 EP - 197 JO - Clinical Breast Cancer JF - Clinical Breast Cancer JA - CLIN BREAST CANCER VL - 14 IS - 3 CY - New York, New York PB - Elsevier B.V. AB - BACKGROUND: In this study we investigated if the 21-gene assay result affects adjuvant decision-making in Japanese women with ER+ invasive EBC. PATIENTS AND METHODS: A total of 124 consecutive eligible patients with ER+, HER2-negative EBC and 0 to 3 positive lymph nodes were enrolled. Treatment recommendations, physicians' confidence and patients' decisional conflict before and after knowledge of the Recurrence Score results of the 21-gene assay were recorded. RESULTS: One-hundred four patients (84%) had N0 disease, including micrometastases, and 20 (16%) had N+ disease. Overall, recommendations changed in 33% (95% CI, 24%-43%) of N0 and 65% (95% CI, 41%-85%) of N+ patients. In 27 of 48 (56%) of N0 and 13 of 15 (87%) of N+ patients an initial recommendation for chemohormonal therapy was revised to only hormonal therapy after assay results, and in 7 of 56 (13%) of N0 and 0 of 5 N+ patients from only hormonal to combined chemohormonal therapy. Decisions appeared to follow the Recurrence Score results for low and high values. For patients with intermediate Recurrence Score values, overall recommendations for chemohormonal treatment tended to decrease after assay results. Physicians' confidence increased in 106 of 124 (85.5%; 95% CI, 78%-91%) cases. Patients' decisional conflict significantly improved as indicated by changes in the total score and the 5 defined subscores (P = .014 for Informed Subscore; P < .001 for all others). CONCLUSION: Results from this prospective study in a Japanese population confirm an effect of the 21-gene assay results on adjuvant treatment decision-making, consistent with reported experiences from the United States and Europe. SN - 1526-8209 AD - St Luke's International Hospital, Department of Breast Surgery, Tokyo, Japan. Electronic address: hideyama@luke.or.jp. AD - St Luke's International Hospital, Department of Breast Surgery, Tokyo, Japan. AD - Saitama Cancer Center, Division of Breast Surgery, Saitama, Japan. AD - Genomic Health, Inc, Redwood City, CA. AD - Medical Affairs Consulting, Speyer, Germany. AD - St Luke's International Hospital, Department of Breast Surgery, Tokyo, Japan; Department of Breast Surgery, Showa University, Tokyo, Japan. U2 - PMID: 24321102. DO - 10.1016/j.clbc.2013.10.017 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107793438&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 103822560 T1 - Segmentation of histopathology HER2/neu images with fuzzy decision tree and Takagi-Sugeno reasoning. AU - Tabakov, Martin AU - Kozak, Pawel Y1 - 2014/06// N1 - Accession Number: 103822560. Language: English. Entry Date: 20150206. Revision Date: 20150710. Publication Type: Journal Article. Journal Subset: Biomedical; Computer/Information Science; USA. NLM UID: 1250250. KW - Breast Neoplasms KW - Logic KW - Histocytochemistry -- Methods KW - Image Interpretation, Computer Assisted -- Methods KW - Receptors, Cell Surface KW - Carcinoma, Ductal, Breast KW - Decision Trees KW - Female KW - Models, Statistical KW - Receptors, Cell Surface -- Analysis SP - 19 EP - 29 JO - Computers in Biology & Medicine JF - Computers in Biology & Medicine JA - COMPUT BIOL MED VL - 49 CY - Philadelphia, Pennsylvania PB - Elsevier B.V. SN - 0010-4825 AD - Institute of Informatics, Wroclaw University of Technology, Poland. Electronic address: martin.tabakow@pwr.wroc.pl. AD - Institute of Informatics, Wroclaw University of Technology, Poland. Electronic address: 183610@student.pwr.wroc.pl. U2 - PMID: 24709057. DO - 10.1016/j.compbiomed.2014.03.001 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103822560&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 103960272 T1 - Multi-criteria decision analysis of breast cancer control in low- and middle-income countries: development of a rating tool for policy makers. AU - Venhorst, Kristie AU - Zelle, Sten G. AU - Tromp, Noor AU - Lauer, Jeremy A. Y1 - 2014/06// N1 - Accession Number: 103960272. Language: English. Entry Date: 20140611. Revision Date: 20150710. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Health Services Administration; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care; Women's Health. Instrumentation: Breast Cancer Intervention Rating Tool. Grant Information: Susan G. Komen for the Cure.. NLM UID: 101170476. KW - Breast Neoplasms -- Prevention and Control -- Developing Countries KW - Decision Support Techniques -- Methods KW - Health Resource Allocation -- Methods KW - Instrument Construction KW - Human KW - Funding Source KW - Developing Countries KW - Expert Clinicians KW - Delphi Technique KW - World Health Organization KW - Cost Benefit Analysis KW - Health Services Accessibility KW - Health Impact Assessment KW - Patient Safety KW - Multimethod Studies KW - Summated Rating Scaling KW - Scales SP - 1 EP - 21 JO - Cost Effectiveness & Resource Allocation JF - Cost Effectiveness & Resource Allocation JA - COST EFFECT RESOURCE ALLOCATION VL - 12 IS - 1 PB - BioMed Central AB - Background The objective of this study was to develop a rating tool for policy makers to prioritize breast cancer interventions in low- and middle- income countries (LMICs), based on a simple multi- criteria decision analysis (MCDA) approach. The definition and identification of criteria play a key role in MCDA, and our rating tool could be used as part of a broader priority setting exercise in a local setting. This tool may contribute to a more transparent priority-setting process and fairer decision-making in future breast cancer policy development. Methods First, an expert panel (n = 5) discussed key considerations for tool development. A literature review followed to inventory all relevant criteria and construct an initial set of criteria. A Delphi study was then performed and questionnaires used to discuss a final list of criteria with clear definitions and potential scoring scales. For this Delphi study, multiple breast cancer policy and priority-setting experts from different LMICs were selected and invited by the World Health Organization. Fifteen international experts participated in all three Delphi rounds to assess and evaluate each criterion. Results This study resulted in a preliminary rating tool for assessing breast cancer interventions in LMICs. The tool consists of 10 carefully crafted criteria (effectiveness, quality of the evidence, magnitude of individual health impact, acceptability, cost-effectiveness, technical complexity, affordability, safety, geographical coverage, and accessibility), with clear definitions and potential scoring scales. Conclusions This study describes the development of a rating tool to assess breast cancer interventions in LMICs. Our tool can offer supporting knowledge for the use or development of rating tools as part of a broader (MCDA based) priority setting exercise in local settings. Further steps for improving the tool are proposed and should lead to its useful adoption in LMICs. SN - 1478-7547 AD - Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands; Knowledge Institute of Medical Specialists, Utrecht, Netherlands AD - Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands AD - Knowledge Institute of Medical Specialists, Utrecht, Netherlands AD - Costs, Effectiveness, Expenditure and Priority Setting, World Health Organization, Geneva, Switzerland DO - 10.1186/1478-7547-12-13 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103960272&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 103938163 T1 - Barriers and facilitators to routine distribution of patient decision support interventions: a preliminary study in community-based primary care settings. AU - Uy, Visith AU - May, Suepattra G. AU - Tietbohl, Caroline AU - Frosch, Dominick L. Y1 - 2014/06// N1 - Accession Number: 103938163. Language: English. Entry Date: 20140502. Revision Date: 20150710. Publication Type: Journal Article; research; tables/charts. Journal Subset: Europe; Health Services Administration; Peer Reviewed; UK & Ireland. NLM UID: 9815926. KW - Decision Making, Clinical KW - Health Services Accessibility -- Evaluation KW - Communities KW - Health Care Delivery -- Evaluation KW - Human KW - Experimental Studies KW - Primary Health Care KW - Colleges and Universities KW - Cancer Screening -- Methods KW - Prostatic Neoplasms -- Diagnosis KW - Colonic Neoplasms -- Diagnosis KW - Diabetes Mellitus KW - Breast Neoplasms KW - Male KW - Female KW - Interviews SP - 353 EP - 364 JO - Health Expectations JF - Health Expectations JA - HEALTH EXPECTATIONS VL - 17 IS - 3 CY - Malden, Massachusetts PB - Wiley-Blackwell AB - Background A growing body of literature documents the value of decision support interventions (DESIs) in facilitating patient participation in preference sensitive decision making, but little is known about their implementation in routine care. Objective This study explored barriers and facilitators to prescribing DESIs in primary care. Setting and participants Four community-based primary care practices across Los Angeles County serving diverse low and middle income populations participated. Design The first phase focused on implementing DESI prescribing into routine care. Weekly academic detailing visits served to identify barriers to DESI prescribing, generate ethnographic field notes and record DESI prescriptions. The second phase explored the impact of a financial incentive on DESI prescribing. At the project's conclusion, each physician completed an in-depth interview. Results The four practices prescribed an average of 6.5 DESIs a month (range 3.6-9.2) during Phase I. The financial incentive increased DESI prescribing by 71% to 11.1 per month (range 3.5-21.4). The estimated percentages of patients who viewed the DESI were 37.9 and 43.9% during Phases I and II, respectively. Qualitative data suggest that physician buy-in with the project goal was crucial to DESI distribution success. Competing demands and time pressures were persistent barriers. The effects of the financial incentive were mixed. Conclusions This study confirmed the importance of physician engagement when implementing DESIs and found mixed effects for providing financial incentives. The relatively low rate of DESI viewing suggests further research on increasing patient uptake of these interventions in routine practice is necessary. SN - 1369-6513 AD - Staff Research Assistant II, Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California Los Angeles (UCLA), Los Angeles, CA AD - Assistant Research Anthropologist AD - Research Assistant AD - Associate Investigator, Palo Alto Medical Foundation Research Institute, Palo Alto, CA; Associate Professor of Medicine, Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California Los Angeles (UCLA), Los Angeles, CA, USA U2 - PMID: 22212453. DO - 10.1111/j.1369-7625.2011.00760.x UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103938163&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 103950720 T1 - Validity of Adjuvant! Online program in older patients with breast cancer: a population-based study. AU - de Glas, Nienke A AU - van de Water, Willemien AU - Engelhardt, Ellen G AU - Bastiaannet, Esther AU - de Craen, Anton J M AU - Kroep, Judith R AU - Putter, Hein AU - Stiggelbout, Anne M AU - Weijl, Nir I AU - van de Velde, Cornelis J H AU - Portielje, Johanneke E A AU - Liefers, Gerrit-Jan Y1 - 2014/06// N1 - Accession Number: 103950720. Language: English. Entry Date: 20140815. Revision Date: 20150710. Publication Type: Journal Article; research. Commentary: Brain Etienne. Breast cancer in older women: predicting adjuvant benefit. (LANCET ONCOL) Jun2014; 15 (7): 672-674. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care. NLM UID: 100957246. KW - Breast Neoplasms -- Drug Therapy KW - Internet KW - Aged KW - Aged, 80 and Over KW - Breast Neoplasms -- Mortality KW - Chemotherapy, Adjuvant KW - Female KW - Human KW - Prospective Studies KW - ROC Curve SP - 722 EP - 729 JO - Lancet Oncology JF - Lancet Oncology JA - LANCET ONCOL VL - 15 IS - 7 CY - New York, New York PB - Elsevier B.V. AB - BACKGROUND: Adjuvant! Online is a prediction tool that can be used to aid clinical decision making in patients with breast cancer. It was developed in a patient population aged 69 years or younger, and subsequent validation studies included small numbers of older patients. Since older patients with breast cancer differ from younger patients in many aspects, the aim of this study was to investigate the validity of Adjuvant! Online in a large cohort of unselected older patients. METHODS: We included patients from the population-based FOCUS cohort, which included all consecutive patients aged 65 years or older who were diagnosed with invasive or in-situ breast cancer between Jan 1, 1997, and Dec 31, 2004, in the southwestern part of the Netherlands. We included all patients who fulfilled the criteria as stated by Adjuvant! Online: patients with unilateral, unicentric, invasive adenocarcinoma; no evidence of metastatic or residual disease; no evidence of T4 features; and no evidence of inflammatory breast cancer. We entered data from all patients with the 'average for age' comorbidity status (model 1) and with an individualised comorbidity status (model 2). FINDINGS: We included 2012 patients. Median age of patients in the cohort was 74·0 years (IQR 69·0-79·0). 904 (45%) of 2012 patients died during follow-up, whereas 326 (16%) patients had recurrence. Median follow-up for overall survival was 9·0 years (IQR 7·4-10·7), and 6·6 years (4·4-6·6) for patients without recurrence. Using model 1, Adjuvant! Online overestimated 10-year overall survival by 9·8% ([95% CI 5·9-13·7], p<0·0001) and 10-year cumulative recurrence survival by 8·7% ([6·7-10·7], p<0·0001). By contrast, when using model 2, Adjuvant! Online underestimated the 10-year overall survival by -17·1% ([95% CI -21·0 to -13·2], p<0·0001). However, when using model 2, Adjuvant! Online predicted cumulative recurrence accurately in all patients (-0·7% [95% CI -2·7-1·3], p=0·48). INTERPRETATION: Adjuvant! Online does not accurately predict overall survival and recurrence in older patients with early breast cancer. FUNDING: Dutch Cancer Foundation. SN - 1470-2045 AD - Department of Surgery, Leiden University Medical Centre, Leiden, Netherlands; Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, Netherlands. AD - Department of Medical Decision Making, Leiden University Medical Centre, Leiden, Netherlands. AD - Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, Netherlands. AD - Department of Medical Oncology, Leiden University Medical Centre, Leiden, Netherlands. AD - Department of Medical Statistics, Leiden University Medical Centre, Leiden, Netherlands. AD - Department of Medical Oncology, Bronovo Hospital The Hague, The Hague, Netherlands. AD - Department of Surgery, Leiden University Medical Centre, Leiden, Netherlands. AD - Department of Medical Oncology, Haga Hospital The Hague, Leyweg The Hague, Netherlands. AD - Department of Surgery, Leiden University Medical Centre, Leiden, Netherlands. Electronic address: g.j.liefers@lumc.nl. U2 - PMID: 24836274. DO - 10.1016/S1470-2045(14)70200-1 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103950720&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 103942267 T1 - Economic return from the Women's Health Initiative estrogen plus progestin clinical trial: a modeling study. AU - Roth, Joshua A AU - Etzioni, Ruth AU - Waters, Teresa M AU - Pettinger, Mary AU - Rossouw, Jacques E AU - Anderson, Garnet L AU - Chlebowski, Rowan T AU - Manson, Joann E AU - Hlatky, Mark AU - Johnson, Karen C AU - Ramsey, Scott D Y1 - 2014/05/06/ N1 - Accession Number: 103942267. Language: English. Entry Date: 20140704. Revision Date: 20161209. Publication Type: journal article; research. Journal Subset: Biomedical; Expert Peer Reviewed; Peer Reviewed; USA. Grant Information: HHSN268201100004C//PHS HHS/United States. NLM UID: 0372351. KW - Cardiovascular Diseases -- Prevention and Control KW - Clinical Trials -- Economics KW - Hormone Replacement Therapy KW - Postmenopause KW - Women's Health KW - Aged KW - Breast Neoplasms -- Epidemiology KW - Cardiovascular Diseases -- Epidemiology KW - Colorectal Neoplasms -- Epidemiology KW - Cost Savings KW - Decision Support Techniques KW - Female KW - Financing, Government KW - Fractures -- Epidemiology KW - Health Care Costs KW - Human KW - Incidence KW - Middle Age KW - National Institutes of Health (U.S.) KW - Osteoporosis -- Complications KW - Osteoporosis -- Epidemiology KW - Osteoporosis -- Prevention and Control KW - Probability KW - Quality-Adjusted Life Years KW - United States SP - 594 EP - 602 JO - Annals of Internal Medicine JF - Annals of Internal Medicine JA - ANN INTERN MED VL - 160 IS - 9 CY - Philadelphia, Pennsylvania PB - American College of Physicians AB - Background: The findings of the Women's Health Initiative (WHI) estrogen plus progestin (E+P) trial led to a substantial reduction in use of combined hormone therapy (cHT) among postmenopausal women in the United States. The economic effect of this shift has not been evaluated relative to the trial's $260 million cost (2012 U.S. dollars).Objective: To estimate the economic return from the WHI E+P trial.Design: Decision model to simulate health outcomes for a "WHI scenario" with observed cHT use and a "no-WHI scenario" with cHT use extrapolated from the pretrial period.Data Sources: Primary analyses of WHI outcomes, peer-reviewed literature, and government sources.Target Population: Postmenopausal women in the United States, aged 50 to 79 years, who did not have a hysterectomy.Time Horizon: 2003 to 2012.Perspective: Payer.Intervention: Combined hormone therapy.Outcome Measures: Disease incidence, expenditure, quality-adjusted life-years, and net economic return.Results Of Base-case Analysis: The WHI scenario resulted in 4.3 million fewer cHT users, 126,000 fewer breast cancer cases, 76,000 fewer cardiovascular disease cases, 263,000 more fractures, 145,000 more quality-adjusted life-years, and expenditure savings of $35.2 billion. The corresponding net economic return of the trial was $37.1 billion ($140 per dollar invested in the trial) at a willingness-to-pay level of $100,000 per quality-adjusted life-year.Results Of Sensitivity Analysis: The 95% CI for the net economic return of the trial was $23.1 to $51.2 billion.Limitation: No evaluation of indirect costs or outcomes beyond 2012.Conclusion: The WHI E+P trial made high-value use of public funds with a substantial return on investment. These results can contribute to discussions about the role of public funding for large, prospective trials with high potential for public health effects.Primary Funding Source: National Heart, Lung, and Blood Institute. SN - 0003-4819 U2 - PMID: 24798522. DO - 10.7326/M13-2348 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103942267&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 103942070 T1 - Evaluating population-based breast cancer surgical practice in real time with a web-based synoptic operative reporting system. AU - Temple, Walley J AU - Chin-Lenn, Laura AU - Mack, Lloyd A Y1 - 2014/05// N1 - Accession Number: 103942070. Corporate Author: Cancer Surgery Alberta. Language: English. Entry Date: 20140711. Revision Date: 20150710. Publication Type: Journal Article; research. Journal Subset: Biomedical; USA. Special Interest: Perioperative Care. NLM UID: 0370473. KW - Breast Neoplasms -- Surgery KW - Carcinoma, Ductal, Breast -- Surgery KW - Guideline Adherence -- Statistics and Numerical Data KW - Internet KW - Mastectomy -- Utilization KW - Patient Record Systems KW - Practice Patterns -- Statistics and Numerical Data KW - Alberta KW - Decision Support Techniques KW - Female KW - Guideline Adherence -- Trends KW - Human KW - Lumpectomy -- Statistics and Numerical Data KW - Lumpectomy -- Trends KW - Lumpectomy -- Utilization KW - Mastectomy -- Statistics and Numerical Data KW - Mastectomy -- Trends KW - Patient Satisfaction KW - Practice Patterns -- Trends KW - Practice Guidelines KW - Data Collection SP - 693 EP - 697 JO - American Journal of Surgery JF - American Journal of Surgery JA - AM J SURG VL - 207 IS - 5 CY - Philadelphia, Pennsylvania PB - Elsevier B.V. SN - 0002-9610 AD - Department of Surgery and Oncology, University of Calgary, Calgary, AB, Canada. AD - Department of Surgery and Oncology, University of Calgary, Calgary, AB, Canada. Electronic address: lloyd.mack@albertahealthservices.ca. U2 - PMID: 24576583. DO - 10.1016/j.amjsurg.2013.12.013 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103942070&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104053327 T1 - Breast cancer survivors willingness to participate in an acupuncture clinical trial: a qualitative study. AU - Schapira, Marilyn M AU - Mackenzie, Elizabeth R AU - Lam, Regina AU - Casarett, David AU - Seluzicki, Christina M AU - Barg, Frances K AU - Mao, Jun J Y1 - 2014/05// N1 - Accession Number: 104053327. Language: English. Entry Date: 20140704. Revision Date: 20161119. Publication Type: journal article; research. Journal Subset: Biomedical; Continental Europe; Double Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed. Special Interest: Oncologic Care. Grant Information: R21 AT004695/AT/NCCIH NIH HHS/United States. NLM UID: 9302957. KW - Acupuncture -- Psychosocial Factors KW - Breast Neoplasms -- Psychosocial Factors KW - Breast Neoplasms -- Therapy KW - Patient Attitudes KW - Acupuncture -- Methods KW - Adult KW - Aged KW - Blacks -- Psychosocial Factors KW - Breast Neoplasms -- Ethnology KW - Breast Neoplasms -- Pathology KW - Decision Making KW - Female KW - Human KW - Middle Age KW - Neoplasm Recurrence, Local -- Ethnology KW - Neoplasm Recurrence, Local -- Psychosocial Factors KW - Neoplasm Recurrence, Local -- Therapy KW - Neoplasm Staging KW - Patient Attitudes -- Ethnology KW - Survivors -- Psychosocial Factors KW - Whites -- Psychosocial Factors SP - 1207 EP - 1215 JO - Supportive Care in Cancer JF - Supportive Care in Cancer JA - SUPPORT CARE CANCER VL - 22 IS - 5 CY - , PB - Springer Science & Business Media B.V. AB - Purpose: Acupuncture is a complementary and alternative medicine (CAM) modality that shows promise as a component of supportive breast cancer care. Lack of robust recruitment for clinical trial entry has limited the evidence base for acupuncture as a treatment modality among breast cancer survivors. The objective of this study is to identify key decision-making factors among breast cancer survivors considering entry into an acupuncture clinical trial for treatment of symptoms.Methods: Semistructured interviews were conducted among African-American (n=12) and Caucasian (n=13) breast cancer survivors. Verbatim transcripts were made and analyzed by two or more independent coders using NVivo software. Major recurring themes were identified and a theoretical framework developed.Results: Six themes emerged reflecting key attributes of the decision to enter a clinical trial: (1) symptom appraisal, (2) practical barriers (e.g., distance and travel), (3) beliefs about the interventions (e.g., fear of needles and dislike of medications), (4) comfort with elements of clinical trial design (e.g., randomization, the nature of the control intervention, and blinding), (5) trust, and (6) altruism. African-American and Caucasian women weighed similar attributes but differed in the information sources sought regarding clinical trial entry and in concerns regarding the use of a placebo in a clinical trial.Conclusions: Our findings contribute to the development of a theoretical model of decision making for breast cancer survivors considering participation in a CAM clinical trial. Insights regarding the decision making process can inform interventions to support informed decision making and robust recruitment to CAM trials among cancer survivors. SN - 0941-4355 AD - The Philadelphia VA Center for Health Equity Research and Promotion, University of Pennsylvania, Philadelphia, PA, USA, mschap@upenn.edu. U2 - PMID: 24362843. DO - 10.1007/s00520-013-2073-3 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104053327&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104058187 T1 - A systematic assessment of benefits and risks to guide breast cancer screening decisions. AU - Pace, Lydia E AU - Keating, Nancy L Y1 - 2014/04/02/ N1 - Accession Number: 104058187. Language: English. Entry Date: 20140502. Revision Date: 20161112. Publication Type: journal article; research; systematic review. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Evidence-Based Practice. NLM UID: 7501160. KW - Breast Neoplasms -- Mortality KW - Breast Neoplasms -- Radiography KW - Early Detection of Cancer KW - Mammography -- Adverse Effects KW - Mammography -- Statistics and Numerical Data KW - Adult KW - Age Factors KW - Aged KW - Clinical Trials KW - Decision Making KW - False Positive Results KW - Female KW - Human KW - Literature KW - Medical Practice, Evidence-Based KW - Medline KW - Meta Analysis KW - Middle Age KW - Practice Guidelines KW - Risk Factors KW - Systematic Review SP - 1327 EP - 1335 JO - JAMA: Journal of the American Medical Association JF - JAMA: Journal of the American Medical Association JA - JAMA VL - 311 IS - 13 CY - Chicago, Illinois PB - American Medical Association AB - Importance: Breast cancer is the second leading cause of cancer deaths among US women. Mammography screening may be associated with reduced breast cancer mortality but can also cause harm. Guidelines recommend individualizing screening decisions, particularly for younger women.Objectives: We reviewed the evidence on the mortality benefit and chief harms of mammography screening and what is known about how to individualize mammography screening decisions, including communicating risks and benefits to patients.Evidence Acquisition: We searched MEDLINE from 1960-2014 to describe (1) benefits of mammography, (2) harms of mammography, and (3) individualizing screening decisions and promoting informed decision making. We also manually searched reference lists of key articles retrieved, selected reviews, meta-analyses, and practice recommendations. We rated the level of evidence using the American Heart Association guidelines.Results: Mammography screening is associated with a 19% overall reduction of breast cancer mortality (approximately 15% for women in their 40s and 32% for women in their 60s). For a 40- or 50-year-old woman undergoing 10 years of annual mammograms, the cumulative risk of a false-positive result is about 61%. About 19% of the cancers diagnosed during that 10-year period would not have become clinically apparent without screening (overdiagnosis), although there is uncertainty about this estimate. The net benefit of screening depends greatly on baseline breast cancer risk, which should be incorporated into screening decisions. Decision aids have the potential to help patients integrate information about risks and benefits with their own values and priorities, although they are not yet widely available for use in clinical practice.Conclusions and Relevance: To maximize the benefit of mammography screening, decisions should be individualized based on patients' risk profiles and preferences. Risk models and decision aids are useful tools, but more research is needed to optimize these and to further quantify overdiagnosis. Research should also explore other breast cancer screening strategies. SN - 0098-7484 AD - Division of Women's Health, Brigham and Women's Hospital, Boston, Massachusetts. AD - Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts3Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts. U2 - PMID: 24691608. DO - 10.1001/jama.2014.1398 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104058187&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104058133 T1 - Nottingham Prognostic Index Plus (NPI+): a modern clinical decision making tool in breast cancer. AU - Rakha, E A AU - Soria, D AU - Green, A R AU - Lemetre, C AU - Powe, D G AU - Nolan, C C AU - Garibaldi, J M AU - Ball, G AU - Ellis, I O Y1 - 2014/04//4/1/2014 N1 - Accession Number: 104058133. Language: English. Entry Date: 20140613. Revision Date: 20170929. Publication Type: journal article; research. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care. Grant Information: //Medical Research Council/United Kingdom. NLM UID: 0370635. KW - Breast Neoplasms -- Diagnosis KW - Decision Making KW - Severity of Illness Indices KW - Tumor Markers, Biological -- Metabolism KW - Adult KW - Aged KW - Body Weights and Measures KW - Breast Neoplasms -- Pathology KW - Breast Neoplasms -- Therapy KW - Female KW - Gene Expression Profiling KW - Human KW - Middle Age KW - Prognosis KW - Survival Analysis KW - Tumor Markers, Biological SP - 1688 EP - 1697 JO - British Journal of Cancer JF - British Journal of Cancer JA - BR J CANCER VL - 110 IS - 7 CY - London, PB - Nature Publishing Group AB - Background: Current management of breast cancer (BC) relies on risk stratification based on well-defined clinicopathologic factors. Global gene expression profiling studies have demonstrated that BC comprises distinct molecular classes with clinical relevance. In this study, we hypothesised that molecular features of BC are a key driver of tumour behaviour and when coupled with a novel and bespoke application of established clinicopathologic prognostic variables can predict both clinical outcome and relevant therapeutic options more accurately than existing methods.Methods: In the current study, a comprehensive panel of biomarkers with relevance to BC was applied to a large and well-characterised series of BC, using immunohistochemistry and different multivariate clustering techniques, to identify the key molecular classes. Subsequently, each class was further stratified using a set of well-defined prognostic clinicopathologic variables. These variables were combined in formulae to prognostically stratify different molecular classes, collectively known as the Nottingham Prognostic Index Plus (NPI+). The NPI+ was then used to predict outcome in the different molecular classes.Results: Seven core molecular classes were identified using a selective panel of 10 biomarkers. Incorporation of clinicopathologic variables in a second-stage analysis resulted in identification of distinct prognostic groups within each molecular class (NPI+). Outcome analysis showed that using the bespoke NPI formulae for each biological BC class provides improved patient outcome stratification superior to the traditional NPI.Conclusion: This study provides proof-of-principle evidence for the use of NPI+ in supporting improved individualised clinical decision making. SN - 0007-0920 AD - 1] Breast Cancer Pathology Research Group, Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, UK [2] Cellular Pathology, The Breast Institute, Nottingham University Hospitals NHS Trust, Nottingham, UK. AD - 1] School of Computer Science, University of Nottingham, Nottingham, UK [2] Advanced Data Analysis Centre, University of Nottingham, Nottingham, UK. AD - Breast Cancer Pathology Research Group, Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, UK. AD - College of Arts and Science, School of Science and Technology, Nottingham Trent University, Nottingham, UK. AD - Cellular Pathology, The Breast Institute, Nottingham University Hospitals NHS Trust, Nottingham, UK. AD - School of Computer Science, University of Nottingham, Nottingham, UK. U2 - PMID: 24619074. DO - 10.1038/bjc.2014.120 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104058133&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104011592 T1 - Molecular and protein markers for clinical decision making in breast cancer: Today and tomorrow. AU - Harbeck, Nadia AU - Sotlar, Karl AU - Wuerstlein, Rachel AU - Doisneau-Sixou, Sophie Y1 - 2014/04// N1 - Accession Number: 104011592. Language: English. Entry Date: 20140328. Revision Date: 20150710. Publication Type: Journal Article. Journal Subset: Biomedical; Double Blind Peer Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care. NLM UID: 7502030. KW - Breast Neoplasms -- Blood KW - Breast Neoplasms -- Diagnosis KW - Breast Neoplasms -- Therapy KW - Decision Making KW - Early Diagnosis KW - Tumor Markers, Biological -- Blood KW - Combined Modality Therapy -- Methods KW - Female SP - 434 EP - 444 JO - Cancer Treatment Reviews JF - Cancer Treatment Reviews JA - CANCER TREAT REV VL - 40 IS - 3 CY - Philadelphia, Pennsylvania PB - W B Saunders AB - In early breast cancer (eBC), established clinicopathological factors are not sufficient for clinical decision making particularly regarding adjuvant chemotherapy since substantial over- or undertreatment may occur. Thus, novel protein- and molecular markers have been put forward as decision aids. Since these potential prognosis and/or predictive tests differ substantially regarding their methodology, analytical and clinical validation, this review attempts to summarize the essential facts for clinicians. This review focuses on those markers which are the most advanced so far in their development towards routine clinical application, i.e. two protein markers (i.e. uPA/PAI-1 and IHC4) and six molecular multigene tests (i.e. Mammaprint(R), Oncotype DX(R), PAM50, Endopredict(R), the 97-gene genomic grade, and 76 gene Rotterdam signatures). Next to methodological aspects, we summarized the clinical evidences, in particular the main prospective clinical trials which have already been fully recruited (i.e. MINDACT, TAILORx, WSG PLAN B) or are still ongoing (i.e. RxPONDER/SWOG S1007, WSG-ADAPT). Last but not least, this review points out the key elements for clinicians to select one test among the wide panel of proposed assays, for a specific population of patients in term of level of evidence, analytical and clinical validity as well as cost effectiveness. SN - 0305-7372 AD - Brustzentrum, Universitätsfrauenklinik, Klinikum Großhadern, Marchioninistr. 15, München, Germany. Electronic address: Nadia.Harbeck@med.uni-muenchen.de. AD - Pathologisches Institut, Ludwig-Maximilians-Universität München, Thalkirchner Strasse. 36, München, Germany. Electronic address: Karl.Sotlar@med.uni-muenchen.de. AD - Brustzentrum, Klinikum der Universität München, Maistraße 11, 80337 Munich, Germany. Electronic address: Rachel.Wuerstlein@med.uni-muenchen.de. AD - Brustzentrum, Klinikum der Universität München, Maistraße 11, 80337 Munich, Germany; Université Paul Sabatier Toulouse III, Faculté des Sciences Pharmaceutiques, 31062 Toulouse Cedex 09, France. Electronic address: Sophie.DoisneauSixou@med.uni-muenchen.de. U2 - PMID: 24138841. DO - 10.1016/j.ctrv.2013.09.014 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104011592&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104042613 T1 - Evaluation of alternate categorical tumor metrics and cut points for response categorization using the RECIST 1.1 data warehouse. AU - Mandrekar, Sumithra J AU - An, Ming-Wen AU - Meyers, Jeffrey AU - Grothey, Axel AU - Bogaerts, Jan AU - Sargent, Daniel J Y1 - 2014/03/10/ N1 - Accession Number: 104042613. Language: English. Entry Date: 20140516. Revision Date: 20161117. Publication Type: journal article; research. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Oncologic Care. Grant Information: P30 CA015083/CA/NCI NIH HHS/United States. NLM UID: 8309333. KW - Breast Neoplasms -- Therapy KW - Carcinoma, Non-Small-Cell Lung -- Therapy KW - Colorectal Neoplasms -- Therapy KW - Decision Support Systems, Clinical KW - Decision Support Techniques KW - Lung Neoplasms -- Therapy KW - Breast Neoplasms -- Mortality KW - Breast Neoplasms KW - Carcinoma, Non-Small-Cell Lung -- Mortality KW - Carcinoma, Non-Small-Cell Lung -- Pathology KW - Colorectal Neoplasms -- Mortality KW - Colorectal Neoplasms -- Pathology KW - Discriminant Analysis KW - Disease Progression KW - Prognosis KW - Female KW - Human KW - Kaplan-Meier Estimator KW - Lung Neoplasms -- Mortality KW - Lung Neoplasms -- Pathology KW - Male KW - Predictive Value of Tests KW - Cox Proportional Hazards Model KW - Disease Remission KW - Reproducibility of Results KW - Risk Factors KW - Time Factors KW - Treatment Outcomes KW - Body Weights and Measures SP - 841 EP - 850 JO - Journal of Clinical Oncology JF - Journal of Clinical Oncology JA - J CLIN ONCOL VL - 32 IS - 8 CY - Alexandria, Virginia PB - American Society of Clinical Oncology AB - Purpose: We sought to test and validate the predictive utility of trichotomous tumor response (TriTR; complete response [CR] or partial response [PR] v stable disease [SD] v progressive disease [PD]), disease control rate (DCR; CR/PR/SD v PD), and dichotomous tumor response (DiTR; CR/PR v others) metrics using alternate cut points for PR and PD. The data warehouse assembled to guide the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 was used.Methods: Data from 13 trials (5,480 patients with metastatic breast cancer, non-small-cell lung cancer, or colorectal cancer) were randomly split (60:40) into training and validation data sets. In all, 27 pairs of cut points for PR and PD were considered: PR (10% to 50% decrease by 5% increments) and PD (10% to 20% increase by 5% increments), for which 30% and 20% correspond to the RECIST categorization. Cox proportional hazards models with landmark analyses at 12 and 24 weeks stratified by study and number of lesions (fewer than three v three or more) and adjusted for average baseline tumor size were used to assess the impact of each metric on overall survival (OS). Model discrimination was assessed by using the concordance index (c-index).Results: Standard RECIST cut points demonstrated predictive ability similar to the alternate PR and PD cut points. Regardless of tumor type, the TriTR, DiTR, and DCR metrics had similar predictive performance. The 24-week metrics (albeit with higher c-index point estimate) were not meaningfully better than the 12-week metrics. None of the metrics did particularly well for breast cancer.Conclusion: Alternative cut points to RECIST standards provided no meaningful improvement in OS prediction. Metrics assessed at 12 weeks have good predictive performance. SN - 0732-183X AD - Sumithra J. Mandrekar, Jeffrey Meyers, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Ming-Wen An, Vassar College, Poughkeepsie, NY; and Jan Bogaerts, European Organisation for Research and Treatment of Cancer, Brussels, Belgium. U2 - PMID: 24516033. DO - 10.1200/JCO.2013.52.3019 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104042613&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107894023 T1 - Psychosocial and Cultural Reasons for Delay in Seeking Help and Nonadherence to Treatment in Indonesian Women With Breast Cancer: A Qualitative Study. AU - Iskandarsyah, Aulia AU - de Klerk, Cora AU - Suardi, Dradjat R. AU - Soemitro, Monty P. AU - Sadarjoen, Sawitri S. AU - Passchier, Jan Y1 - 2014/03// N1 - Accession Number: 107894023. Language: English. Entry Date: 20140314. Revision Date: 20150712. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Oncologic Care; Psychiatry/Psychology; Women's Health. NLM UID: 8211523. KW - Help Seeking Behavior KW - Treatment Delay KW - Cultural Values KW - Patient Compliance KW - Breast Neoplasms -- Indonesia KW - Cancer Patients -- Psychosocial Factors -- Indonesia KW - Human KW - Indonesia KW - Qualitative Studies KW - Semi-Structured Interview KW - Purposive Sample KW - Thematic Analysis KW - Coding KW - Grounded Theory KW - Female KW - Adult KW - Middle Age KW - Neoplasm Staging KW - Health Beliefs SP - 214 EP - 221 JO - Health Psychology JF - Health Psychology JA - HEALTH PSYCHOL VL - 33 IS - 3 CY - Washington, District of Columbia PB - American Psychological Association AB - Objective: The aim of this study was to explore reasons for delay in seeking medical help and nonadherence to treatment in Indonesian women with breast cancer. Method: Semi structured interviews were conducted by purposive sampling, using a consecutive sample of 50 breast cancer patients who were treated at the Outpatient Surgical Oncology Clinic of Hasan Sadikin Hospital in Bandung, Indonesia. Interviews were recorded, transcribed verbatim, and coded using qualitative software. Codes were merged into main themes that were subsequently mapped onto the study's aim. Results: Eight main themes concerning reasons for delay in seeking medical help and treatment nonadherence emerged, namely: lack of awareness and knowledge, cancer beliefs, treatment beliefs, financial problems, emotional burden, severe side effects, paternalistic style of communication, and unmet information needs. Conclusion: This study has identified several modifiable psychosocial and cultural factors related to delay in seeking help and nonadherence to treatment in breast cancer patients. We suggest that the provision of extensive information through media campaigns, treatment decision aids, and caregiver and patient education are needed to change the illness behaviors of Indonesian breast cancer patients. SN - 0278-6133 AD - Erasmus MC University Medical Centre, Rotterdam, the Netherlands; VU University; Padjadjaran University AD - Erasmus MC University Medical Centre, Rotterdam, the Netherlands AD - Hasan Sadikin Hospital, Bandung, Indonesia AD - Padjadjaran University AD - Erasmus MC University Medical Centre, Rotterdam, the Netherlands; VU University U2 - PMID: 23339645. DO - 10.1037/a0031060 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107894023&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104037307 T1 - Development and evaluation of a decision aid on mammography screening for women 75 years and older. AU - Schonberg, Mara A AU - Hamel, Mary Beth AU - Davis, Roger B AU - Griggs, M Cecilia AU - Wee, Christina C AU - Fagerlin, Angela AU - Marcantonio, Edward R Y1 - 2014/03// N1 - Accession Number: 104037307. Language: English. Entry Date: 20140516. Revision Date: 20161117. Publication Type: journal article; research. Journal Subset: Biomedical; Peer Reviewed; USA. Grant Information: K24 AG035075/AG/NIA NIH HHS/United States. NLM UID: 101589534. KW - Breast Neoplasms -- Diagnosis KW - Decision Support Techniques KW - Early Detection of Cancer KW - Mammography KW - Consumer Participation KW - Aged KW - Aged, 80 and Over KW - Breast Neoplasms -- Prevention and Control KW - Decision Making KW - Female KW - Attitude to Health KW - Human KW - Women's Health SP - 417 EP - 424 JO - JAMA Internal Medicine JF - JAMA Internal Medicine JA - JAMA INTERN MED VL - 174 IS - 3 CY - Chicago, Illinois PB - American Medical Association AB - Importance: Guidelines recommend that women 75 years and older should be informed of the benefits and risks of mammography before being screened. However, few are adequately informed.Objectives: To develop and evaluate a mammography screening decision aid (DA) for women 75 years and older.Design: We designed the DA using international standards. Between July 14, 2010, and April 10, 2012, participants completed a pretest survey and read the DA before an appointment with their primary care physician. They completed a posttest survey after their appointment. Medical records were reviewed for follow-up information.Setting and Participants: Boston, Massachusetts, academic primary care practice. Eligible women were aged 75 to 89 years, English speaking, had not had a mammogram in 9 months but had been screened within the past 3 years, and did not have a history of dementia or invasive or noninvasive breast cancer. Of 84 women approached, 27 declined to participate, 12 were unable to complete the study for logistical reasons, and 45 participated.Interventions: The DA includes information on breast cancer risk, life expectancy, competing mortality risks, possible outcomes of screening, and a values clarification exercise.Main Outcomes and Measures: Knowledge of the benefits and risks of screening, decisional conflict, and screening intentions; documentation in the medical record of a discussion of the risks and benefits of mammography with a primary care physician within 6 months; and the receipt of screening within 15 months. We used the Wilcoxon signed rank test and McNemar test to compare pretest-posttest information.Results: The median age of participants was 79 years, 69% (31 of 45) were of non-Hispanic white race/ethnicity, and 60% (27 of 45) had attended at least some college. Comparison of posttest results with pretest results demonstrated 2 findings. First, knowledge of the benefits and risks of screening improved (P < .001). Second, fewer participants intended to be screened (56% [25 of 45] afterward compared with 82% [37 of 45] before, P = .03). Decisional conflict declined but not significantly (P = .10). In the following 6 months, 53% (24 of 45) of participants had a primary care physician note that documented the discussion of the risks and benefits of screening compared with 11% (5 of 45) in the previous 5 years (P < .001). While 84% (36 of 43) had been screened within 2 years of participating, 60% (26 of 43) were screened within 15 months after participating (≥ 2 years since their last mammogram) (P = .01). Overall, 93% (42 of 45) found the DA helpful.Conclusions and Relevance: A DA may improve older women's decision making about mammography screening. SN - 2168-6106 AD - Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, and Beth Israel Deaconess Medical Center, Boston, Massachusetts. AD - Center for Bioethics and Social Sciences in Medicine, Departments of Internal Medicine and Psychology, University of Michigan, and Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan. U2 - PMID: 24378846. DO - 10.1001/jamainternmed.2013.13639 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104037307&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104021889 T1 - Decisional support throughout the cancer journey for older women diagnosed with early stage breast cancer: a single institutional study. AU - Presutti, Roseanna AU - D'Alimonte, Laura AU - McGuffin, Merrylee AU - Chen, Hanbert AU - Chow, Edward AU - Pignol, Jean-Philippe AU - Di Prospero, Lisa AU - Doherty, Mary AU - Kiss, Alex AU - Wong, Jennifer AU - Lee, Justin AU - Liu, Stanley AU - Warner, Ellen AU - Trudeau, Maureen AU - Feldman-Stewart, Deb AU - Harth, Tamara AU - Szumacher, Ewa Y1 - 2014/03// N1 - Accession Number: 104021889. Language: English. Entry Date: 20141031. Revision Date: 20171115. Publication Type: journal article; research. Journal Subset: Biomedical; Blind Peer Reviewed; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Health Promotion/Education; Peer Reviewed; USA. Special Interest: Oncologic Care. NLM UID: 8610343. KW - Breast Neoplasms -- Psychosocial Factors KW - Decision Making KW - Decision Support Techniques KW - Patient Care Plans KW - Stress, Psychological KW - Aged KW - Aged, 80 and Over KW - Breast Neoplasms -- Diagnosis KW - Female KW - Human KW - Middle Age KW - Patient Education KW - Physician-Patient Relations KW - Prospective Studies KW - Questionnaires SP - 129 EP - 135 JO - Journal of Cancer Education JF - Journal of Cancer Education JA - J CANCER EDUC VL - 29 IS - 1 CY - , PB - Springer Science & Business Media B.V. AB - To determine if older women with early stage breast cancer have sufficient decisional support during their breast cancer journey, a questionnaire-based study was conducted at the Sunnybrook Odette Cancer Centre, in Toronto, Ontario, Canada. Women with stages I and II breast cancer, ≥60 years, were contacted upon completion of their adjuvant treatment. A questionnaire was developed based on focus groups, the literature, and consultation with patients and a multidisciplinary team of experts. The questionnaire was divided into six domains as follows: (1) information support surrounding diagnosis, (2) impact of cancer diagnosis on the patient, (3) quality of interaction with healthcare team, (4) decisional support from the healthcare team, (5) additional information needs surrounding treatment decision, and (6) information support during radiation treatment. Ninety-two of 137 patients approached were included in the analysis. Ninety percent were > 60 years at the time of diagnosis and 65% had stage I invasive breast cancer. The majority of women received adequate decisional support during their cancer journey. Approximately 90% of women indicated that they received a high level of support during their cancer diagnosis. We found no significant differences in overall decisional support based on age at diagnosis, education level, ethnicity, or the presence of co-morbidities. However, participants desired additional educational resources such as a worksheet, consultation summary, or workbook to assist in making a treatment decision. The majority of participants felt that they had sufficient support while making a treatment decision for breast cancer. SN - 0885-8195 AD - Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, Canada, M4N 3M5. U2 - PMID: 24092532. DO - 10.1007/s13187-013-0558-x UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104021889&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104021897 T1 - Informational needs of patients with metastatic breast cancer: what questions do they ask, and are physicians answering them? AU - Danesh, M AU - Belkora, J AU - Volz, S AU - Rugo, H S Y1 - 2014/03// N1 - Accession Number: 104021897. Language: English. Entry Date: 20141031. Revision Date: 20171115. Publication Type: journal article; research. Journal Subset: Biomedical; Blind Peer Reviewed; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Health Promotion/Education; Peer Reviewed; USA. Special Interest: Oncologic Care. NLM UID: 8610343. KW - Breast Neoplasms -- Psychosocial Factors KW - Health Services Needs and Demand KW - Patient Education -- Methods KW - Physician-Patient Relations KW - Physicians -- Psychosocial Factors KW - Breast Neoplasms KW - Breast Neoplasms -- Therapy KW - Decision Making KW - Female KW - Human KW - Male KW - Middle Age KW - Palliative Care KW - Consumer Participation KW - Prognosis KW - Quality of Life KW - Questionnaires SP - 175 EP - 180 JO - Journal of Cancer Education JF - Journal of Cancer Education JA - J CANCER EDUC VL - 29 IS - 1 CY - , PB - Springer Science & Business Media B.V. AB - In the setting of breast oncology consultations, we sought to understand communication patterns between patients with advanced breast cancer and their oncologists during visits with Decision Support Services. This is a descriptive study analyzing themes and their frequencies of premeditated question lists of patients with metastatic breast cancer. We identified topics physicians most commonly discussed among themes previously found, documenting questions patients with metastatic breast cancer prepare for physician consultations and oncologists' response. Inclusion criteria were as follows: diagnosis of metastatic breast cancer, completion of a question list before meeting with an oncologist, and receipt of a summary of the consultation. We identified 59 women with metastatic breast cancer who received both documents. We reviewed the question lists and consultation summaries of these patients. Of the 59 patients whose documents we reviewed, patients most often asked about prognosis (38), symptom management (31), clinical trials (43), and quality of life (38). Physicians answered questions about prognosis infrequently (37% of the time); other questions that were answered more than commonly are the following: symptom management (81%), clinical trials (79%), and quality of life (66%). Breast cancer patients have many questions regarding their disease, its treatment, and symptoms, which were facilitated in this setting by Decision Support Services. Question lists may be insufficient to bridge the divide between physicians and patient information needs in the setting of metastatic breast cancer, particularly regarding prognosis. Patients may need additional assistance defining question lists, and physicians may benefit from training in communication, particularly regarding discussions of prognosis and end of life. SN - 0885-8195 AD - , 1233 Arguello Blvd, San Francisco, CA, 94122, USA, melissa.danesh@ucsf.edu. U2 - PMID: 24142513. DO - 10.1007/s13187-013-0566-x UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104021897&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104018017 T1 - Is lack of surgery for older breast cancer patients in the UK explained by patient choice or poor health? A prospective cohort study. AU - Lavelle, K AU - Sowerbutts, A M AU - Bundred, N AU - Pilling, M AU - Degner, L AU - Stockton, C AU - Todd, C Y1 - 2014/02/04/ N1 - Accession Number: 104018017. Language: English. Entry Date: 20140418. Revision Date: 20170928. Publication Type: journal article; research. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care. Grant Information: PDF/01/2008/027//Department of Health/United Kingdom. NLM UID: 0370635. KW - Age Factors KW - Breast Neoplasms -- Epidemiology KW - Breast Neoplasms -- Surgery KW - Aged KW - Aged, 80 and Over KW - Breast Neoplasms -- Pathology KW - Decision Making KW - Prospective Studies KW - Female KW - Human KW - Logistic Regression SP - 573 EP - 583 JO - British Journal of Cancer JF - British Journal of Cancer JA - BR J CANCER VL - 110 IS - 3 CY - London, PB - Nature Publishing Group AB - Background: Older women have lower breast cancer surgery rates than younger women. UK policy states that differences in cancer treatment by age can only be justified by patient choice or poor health.Methods: We investigate whether lack of surgery for older patients is explained by patient choice/poor health in a prospective cohort study of 800 women aged ≥70 years diagnosed with operable (stage 1-3a) breast cancer at 22 English breast cancer units in 2010-2013.Data Collection: interviews and case note review.Outcome Measure: surgery for operable (stage 1-3a) breast cancer <90 days of diagnosis. Logistic regression adjusts for age, health measures, tumour characteristics, socio-demographics and patient's/surgeon's perceived responsibility for treatment decisions.Results: In the univariable analyses, increasing age predicts not undergoing surgery from the age of 75 years, compared with 70-74-year-olds. Adjusting for health measures and choice, only women aged ≥85 years have reduced odds of surgery (OR 0.18, 95% CI: 0.07-0.44). Each point increase in Activities of Daily Living score (worsening functional status) reduced the odds of surgery by over a fifth (OR 0.23, 95% CI: 0.15-0.35). Patient's role in the treatment decisions made no difference to whether they received surgery or not; those who were active/collaborative were as likely to get surgery as those who were passive, that is, left the decision up to the surgeon.Conclusion: Lower surgery rates, among older women with breast cancer, are unlikely to be due to patients actively opting out of having this treatment. However, poorer health explains the difference in surgery between 75-84-year-olds and younger women. Lack of surgery for women aged ≥85 years persists even when health and patient choice are adjusted for. SN - 0007-0920 AD - 1] School of Nursing, Midwifery & Social Work, Jean McFarlane Building, University Place, The University of Manchester, Oxford Road, Manchester M13 9PL, UK [2] Manchester Academic Health Sciences Centre (MAHSC), Core Technology Facility, 46 Grafton Street, Manchester M13 9NT, UK. AD - 1] Manchester Academic Health Sciences Centre (MAHSC), Core Technology Facility, 46 Grafton Street, Manchester M13 9NT, UK [2] Nightingale and Genesis Prevention Centre, University Hospital of South Manchester NHS Foundation Trust, Wythenshawe Hospital, Southmoor Road, Manchester M23 9LT, UK. U2 - PMID: 24292450. DO - 10.1038/bjc.2013.734 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104018017&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104041073 T1 - Women's decision satisfaction and psychological distress following early breast cancer treatment: a treatment decision support role for nurses. AU - Budden, Lea M AU - Hayes, Barbara A AU - Buettner, Petra G Y1 - 2014/02// N1 - Accession Number: 104041073. Language: English. Entry Date: 20140305. Revision Date: 20150819. Publication Type: Journal Article; research. Journal Subset: Australia & New Zealand; Core Nursing; Double Blind Peer Reviewed; Nursing; Peer Reviewed. Special Interest: Oncologic Care; Women's Health. Instrumentation: Global Severity Index (GSI); Brief Symptom Inventory-18(BSI-18); Treatment Decision Satisfaction Questionnaire(TDSQ). NLM UID: 9613615. KW - Decision Making, Patient KW - Cancer Patients -- Psychosocial Factors KW - Breast Neoplasms -- Therapy KW - Stress, Psychological KW - Patient Satisfaction KW - Human KW - Female KW - Prospective Studies KW - Cross Sectional Studies KW - Descriptive Research KW - Descriptive Statistics KW - Patient Satisfaction -- Evaluation KW - Questionnaires KW - Australia KW - Stress, Psychological -- Evaluation KW - Convenience Sample KW - Scales KW - Wilcoxon Rank Sum Test KW - Kruskal-Wallis Test KW - Chi Square Test KW - Spearman's Rank Correlation Coefficient KW - Adult KW - Middle Age KW - Aged KW - Aged, 80 and Over KW - Multivariate Analysis KW - Confidence Intervals KW - Regression KW - Age Factors KW - Educational Status KW - Depression KW - Anxiety SP - 8 EP - 16 JO - International Journal of Nursing Practice JF - International Journal of Nursing Practice JA - INT J NURS PRACT VL - 20 IS - 1 CY - Malden, Massachusetts PB - Wiley-Blackwell AB - This prospective cross-sectional study investigated Australian women's ( n = 104) decision satisfaction with cancer treatment decision for early breast cancer as well as their psychological distress 3-4 months following surgery. Women's satisfaction was surveyed using the Treatment Decision Satisfaction Questionnaire, and the Brief Symptom Inventory-18 was used to measure psychological distress. Women who were living alone, who worked as professionals and who were not involved in the decision-making process by their doctors were less likely to be satisfied with their decision process, outcome and their overall treatment decision. Following treatment, 26.0% of women were distressed; 18.3% experienced anxiety; 19.2% somatization; and 27.9% depression. Women who experienced somatization were more likely to be dissatisfied with the treatment decision ( P = 0.003) as were those who reported psychological distress ( P = 0.020). Women who were involved in choosing their treatment were more satisfied with their decision. Many women experienced distress following breast cancer treatment and might have required referral for psychological assessment, management and long-term support. Women who experienced distress were more likely to be dissatisfied with the treatment decision (or vice versa). SN - 1322-7114 AD - School of Nursing, Midwifery & Nutrition, James Cook University AD - School of Public Health and Tropical Medicine, James Cook University U2 - PMID: 24580970. DO - 10.1111/ijn.12243 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104041073&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 103810364 T1 - Treatment decision-making in the medical encounter: Comparing the attitudes of French surgeons and their patients in breast cancer care. AU - Nguyen, Florence AU - Moumjid, Nora AU - Charles, Cathy AU - Gafni, Amiram AU - Whelan, Tim AU - Carrère, Marie-Odile Y1 - 2014/02// N1 - Accession Number: 103810364. Language: English. Entry Date: 20150529. Revision Date: 20150710. Publication Type: Journal Article; research. Journal Subset: Core Nursing; Europe; Health Promotion/Education; Nursing; Peer Reviewed; UK & Ireland. NLM UID: 8406280. KW - Attitude of Health Personnel KW - Breast Neoplasms -- Surgery KW - Decision Making KW - Consumer Participation KW - Patient Satisfaction KW - Physician-Patient Relations KW - Surgeons -- Psychosocial Factors KW - Adult KW - Aged KW - Cross Sectional Studies KW - Female KW - Surveys KW - Human KW - Middle Age KW - Questionnaires SP - 230 EP - 237 JO - Patient Education & Counseling JF - Patient Education & Counseling JA - PATIENT EDUC COUNS VL - 94 IS - 2 PB - Elsevier B.V. AB - OBJECTIVES: To explore attitudes of French surgeons and their patients towards treatment decision-making (TDM) in the medical encounter. METHODS: Surgeons involved in early stage breast cancer and their patients treated in a French cancer care network received a cross-sectional survey questionnaire containing examples of four different approaches to TDM: paternalistic, 'some sharing', informed TDM and, shared TDM. RESULTS: Surgeons' interaction styles were clearly distributed among paternalistic, shared and mixed. The paternalistic approach seemed to be associated with private rather than public practice and with less professional experience. Patients reported a rather low level of participation in TDM, varying by socio-demographic characteristics. One third of patients were dissatisfied with the way their treatment decision had been made. CONCLUSION: Most surgeons reported adopting the 'some sharing' approach. However, one patient out of three reported that they would have liked to participate more in the TDM process. PRACTICE IMPLICATIONS: Surgeons need to ask patients what their preferences for involvement in TDM are and then think about ways to accommodate both their own and patients' preferences regarding the TDM process to be used in each encounter. In addition, decision aids could be offered to surgeons to help them discuss treatment options with their patients. SN - 0738-3991 AD - Lyon University, F-69622 Lyon, France; Lyon 1 University, Villeurbanne, France; CNRS, UMR5824, Groupe d'Analyse et de Théorie Economique Lyon Saint-Etienne, France; Centre Léon Bérard, F-69008 Lyon, France. AD - Lyon University, F-69622 Lyon, France; Lyon 1 University, Villeurbanne, France; CNRS, UMR5824, Groupe d'Analyse et de Théorie Economique Lyon Saint-Etienne, France; Centre Léon Bérard, F-69008 Lyon, France. Electronic address: nora.moumjid@univ-lyon1.fr. AD - CHEPA (Center for Health Economics and Policy Analysis), Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. AD - Juravinski Cancer Centre, Hamilton, Ontario, Canada. U2 - PMID: 24325874. DO - 10.1016/j.pec.2013.07.011 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103810364&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 103810361 T1 - Does the use of shared decision-making consultation behaviors increase treatment decision-making satisfaction among Chinese women facing decision for breast cancer surgery? AU - Lam, Wendy W T AU - Kwok, Marie AU - Chan, Miranda AU - Hung, Wai Ka AU - Ying, Marcus AU - Or, Amy AU - Kwong, Ava AU - Suen, Dacita AU - Yoon, Sungwon AU - Fielding, Richard Y1 - 2014/02// N1 - Accession Number: 103810361. Language: English. Entry Date: 20150529. Revision Date: 20150710. Publication Type: Journal Article; research. Journal Subset: Core Nursing; Europe; Health Promotion/Education; Nursing; Peer Reviewed; UK & Ireland. NLM UID: 8406280. KW - Asians -- Psychosocial Factors KW - Breast Neoplasms -- Psychosocial Factors KW - Decision Making KW - Outcomes (Health Care) KW - Consumer Participation KW - Patient Satisfaction -- Ethnology KW - Adult KW - Breast Neoplasms -- Ethnology KW - Breast Neoplasms -- Surgery KW - China KW - Female KW - Surveys KW - Attitude to Health KW - Human KW - Middle Age KW - Personal Satisfaction KW - Physician-Patient Relations KW - Questionnaires KW - Referral and Consultation KW - Audiorecording SP - 243 EP - 249 JO - Patient Education & Counseling JF - Patient Education & Counseling JA - PATIENT EDUC COUNS VL - 94 IS - 2 PB - Elsevier B.V. AB - OBJECTIVE: To assess the extent to which breast surgical consultations used shared decision making (SDM), identify factors associated with use of SDM, and assess if using SDM increases decision-making satisfaction. METHODS: Two hundred and eighty-three video-recorded diagnostic-treatment decision consultations between breast surgeons and women with breast cancer were assessed using the Decision Analysis System for Oncology (DAS-O) coding system designed for assessing SDM behaviors. Women completed a questionnaire at pre-consultation, one-week post-consultation and one-month post-surgery. Patient outcomes included decision conflict, patient satisfaction with medical consultation, and decision regret. RESULTS: Overall, the level of SDM behaviors was low. The extent of SDM behavior within consultation was related to greater consultation duration (p<0.001), more than one treatment being offered (p<0.001), and fewer questions raised by patients/companions (p<0.05). While use of SDM consultation did not influence post-consultation decision conflict, it increased satisfaction with information given and explained, patients' feelings of trust and confidence in their surgeons, and reduced post-surgical decision regret. CONCLUSION: These breast surgical consultations mostly adopted informed treatment decision-making approaches. Using SDM improved patient consultation and decision satisfaction. PRACTICE IMPLICATIONS: The study findings highlight a need to reinforce the importance of SDM in consultations among breast surgeons. SN - 0738-3991 AD - School of Public Health, The University of Hong Kong, Hong Kong. Electronic address: wwtlam@hku.hk. AD - School of Public Health, The University of Hong Kong, Hong Kong. AD - The Breast Centre, Department of Surgery, Kwong Wah Hospital, Hong Kong. AD - Breast Surgery Division, Department of Surgery, The University of Hong Kong, Hong Kong. U2 - PMID: 24316055. DO - 10.1016/j.pec.2013.11.006 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103810361&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104012785 T1 - Cost effectiveness of a 21-gene recurrence score assay versus Canadian clinical practice in post-menopausal women with early-stage estrogen or progesterone-receptor-positive, axillary lymph-node positive breast cancer. AU - Hannouf, Malek B AU - Xie, Bin AU - Brackstone, Muriel AU - Zaric, Gregory S Y1 - 2014/02// N1 - Accession Number: 104012785. Language: English. Entry Date: 20140725. Revision Date: 20171117. Publication Type: journal article; research. Journal Subset: Australia & New Zealand; Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed. Grant Information: //Canadian Institutes of Health Research/Canada. NLM UID: 9212404. KW - Breast Neoplasms -- Economics KW - Decision Support Techniques KW - Gene Expression Profiling -- Economics KW - Lymph Nodes -- Pathology KW - Proteins KW - Receptors, Cell Surface KW - Antineoplastic Agents, Hormonal -- Economics KW - Antineoplastic Agents, Hormonal -- Therapeutic Use KW - Axilla KW - Breast Neoplasms -- Diagnosis KW - Breast Neoplasms -- Drug Therapy KW - Breast Neoplasms -- Mortality KW - Canada KW - Chemotherapy, Adjuvant -- Adverse Effects KW - Chemotherapy, Adjuvant -- Economics KW - Chemotherapy, Adjuvant -- Methods KW - Cost Benefit Analysis KW - Female KW - Gene Expression Profiling -- Methods KW - Human KW - Probability KW - Menopause KW - Middle Age KW - Models, Statistical KW - Neoplasm Recurrence, Local KW - Neoplasm Staging KW - Practice Guidelines KW - Quality-Adjusted Life Years KW - Risk Assessment SP - 135 EP - 147 JO - PharmacoEconomics JF - PharmacoEconomics JA - PHARMACOECONOMICS VL - 32 IS - 2 PB - Springer Science & Business Media B.V. AB - Background: A 21-gene recurrence score (RS) assay provides a method of guiding treatment decisions in women with early-stage breast cancer (ESBC). We investigated the cost effectiveness of using the RS assay versus current clinical practice (CCP) in post-menopausal women with estrogen- or progesterone-receptor-positive, one to three positive axillary lymph-node ESBC from the perspective of the Canadian public healthcare system.Methods: We developed a decision analytic model to project the lifetime clinical and economic consequences of ESBC. We assumed that the RS assay would classify patients among risk levels (low, intermediate and high) and corresponding adjuvant treatment regimens. The model was parameterized using 7-year follow-up data from the Manitoba Cancer Registry, cost data from Manitoba Health administrative databases and secondary sources. Costs are presented in 2012 Canadian dollars, and future costs and benefits were discounted at 5 %.Results: In the base case analysis, the RS assay compared with CCP led to an increase of 0.08 quality-adjusted life-year (QALY) and an increase in cost of Can$36.2 per person, resulting in an incremental cost-effectiveness ratio (ICER) of Can$464/QALY gained. The ICER was most sensitive to the proportion of women classified to intermediate risk by the RS assay who received adjuvant chemotherapy, and absolute risk of relapse among patients receiving the RS assay.Conclusions: The RS assay is likely to be cost effective in the Canadian healthcare system. Field evaluations of the assay in this patient population will help reduce uncertainty in clinical guidelines for intermediate-range RS-assay values and specific disease outcomes by the RS assay, which are important drivers of ICER. SN - 1170-7690 AD - Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON, N6A 5C1, Canada, mbassamh27@gmail.com. U2 - PMID: 24288208. DO - 10.1007/s40273-013-0115-9 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104012785&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 103998329 T1 - Qualitative interaction trees: a tool to identify qualitative treatment-subgroup interactions. AU - Dusseldorp, Elise AU - Van Mechelen, Iven Y1 - 2014/01/30/ N1 - Accession Number: 103998329. Language: English. Entry Date: 20140822. Revision Date: 20150710. Publication Type: Journal Article. Journal Subset: Biomedical; USA. NLM UID: 8215016. KW - Data Analysis, Statistical KW - Decision Trees KW - Clinical Trials -- Methods KW - Adult KW - Algorithms KW - Breast Neoplasms -- Therapy KW - Computer Simulation KW - Female KW - Middle Age SP - 219 EP - 237 JO - Statistics in Medicine JF - Statistics in Medicine JA - STAT MED VL - 33 IS - 2 CY - Hoboken, New Jersey PB - John Wiley & Sons, Inc. SN - 0277-6715 AD - Statistics Group, Netherlands Organization for Applied Scientific Research (TNO), Wassenaarseweg 56, Leiden, The Netherlands; Department of Psychology, Katholieke Universiteit Leuven, Tiensestraat 102 - bus 3713, Leuven, Belgium. U2 - PMID: 23922224. DO - 10.1002/sim.5933 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103998329&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104161265 T1 - The Effect of Narrative Information in a Publicly Available Patient Decision Aid for Early-Stage Breast Cancer. AU - Shaffer, Victoria A. AU - Tomek, Sara AU - Hulsey, Lukas Y1 - 2014/01/02/ N1 - Accession Number: 104161265. Language: English. Entry Date: 20131127. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Blind Peer Reviewed; Health Promotion/Education; Peer Reviewed; USA. Special Interest: Oncologic Care; Women's Health. Grant Information: This study was supported by grant IIG 0128-1 from the Foundation for Informed Medical Decision Making.. NLM UID: 8908762. KW - Breast Neoplasms -- Epidemiology KW - Neoplasm Staging KW - Decision Making, Patient -- Evaluation KW - Funding Source KW - Human KW - Adult KW - Middle Age KW - Female KW - Videorecording -- Evaluation KW - Descriptive Statistics KW - Data Analysis, Statistical KW - Data Analysis Software KW - Chi Square Test KW - P-Value KW - Random Assignment KW - Multivariate Analysis of Variance KW - Regression SP - 64 EP - 73 JO - Health Communication JF - Health Communication JA - HEALTH COMMUN VL - 29 IS - 1 CY - Philadelphia, Pennsylvania PB - Taylor & Francis Ltd AB - This study was designed to (1) evaluate the effect of narratives used in a popular, publicly available patient decision aid for early-stage breast cancer on hypothetical treatment decisions and attitudes toward the decision aid and (2) explore the moderating effects of participant numeracy, electronic health literacy and decision-making style. Two hundred women were asked to imagine that they had been diagnosed with early-stage breast cancer and viewed one of two versions of a video decision aid for early-stage breast cancer. The narrative version of the aid included stories from breast cancer survivors; the control version had no patient stories. After viewing the video decision aid, participants made a hypothetical treatment choice between lumpectomy with radiation and mastectomy, answered several questions about their decision, and evaluated the quality of the decision aid. Participants received $100 for completing the study. The two conditions differed in their motivations for the treatment decision and perceptions of the aid's trustworthiness and emotionality but showed no differences in preferences for surgical treatments or evaluations of the decision aid's quality. However, the impact of patient narratives was moderated by numeracy and electronic health literacy. Higher levels of numeracy were associated with decreased decisional confidence and lower ratings of trustworthiness for the decision aid in the narrative video condition but not in the control video condition. In contrast, higher levels of electronic health literacy were associated with increased decisional confidence and greater perceptions of trustworthiness and credibility of the decision aid in the narrative video condition but not the control video condition. SN - 1041-0236 AD - Department of Health Sciences and Department of Psychological Sciences, University of Missouri AD - Department of Educational Studies in Psychology, Research Methodology, and Counseling, University of Alabama AD - Department of Psychology, Wichita State University U2 - PMID: 23384155. DO - 10.1080/10410236.2012.717341 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104161265&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 109771669 T1 - Inclusion of KI67 significantly improves performance of the PREDICT prognostication and prediction model for early breast cancer. AU - Wishart, Gordon C AU - Rakha, Emad AU - Green, Andrew AU - Ellis, Ian AU - Ali, Hamid Raza AU - Provenzano, Elena AU - Blows, Fiona M AU - Caldas, Carlos AU - Pharoah, Paul Dp AU - Pharoah, Paul D P Y1 - 2014/01// N1 - Accession Number: 109771669. Language: English. Entry Date: 20150123. Revision Date: 20170929. Publication Type: journal article; research. Journal Subset: Biomedical; Europe; UK & Ireland. Special Interest: Oncologic Care. Grant Information: C490/A10124//Cancer Research UK/United Kingdom. NLM UID: 100967800. KW - Breast Neoplasms KW - Breast Neoplasms -- Pathology KW - Models, Theoretical KW - Receptors, Cell Surface -- Analysis KW - Tumor Markers, Biological -- Analysis KW - Adult KW - Body Weights and Measures KW - Breast Neoplasms -- Mortality KW - Female KW - Human KW - Middle Age KW - Neoplasm Metastasis KW - Pharmacokinetics KW - Predictive Value of Tests KW - Prognosis KW - Proteins -- Analysis KW - ROC Curve SP - 908 EP - 908 JO - BMC Cancer JF - BMC Cancer JA - BMC CANCER VL - 14 IS - 1 PB - BioMed Central AB - Background: PREDICT (http://www.predict.nhs.uk) is a prognostication and treatment benefit tool for early breast cancer (EBC). The aim of this study was to incorporate the prognostic effect of KI67 status in a new version (v3), and compare performance with the Predict model that includes HER2 status (v2).Methods: The validation study was based on 1,726 patients with EBC treated in Nottingham between 1989 and 1998. KI67 positivity for PREDICT is defined as >10% of tumour cells staining positive. ROC curves were constructed for Predict models with (v3) and without (v2) KI67 input. Comparison was made using the method of DeLong.Results: In 1274 ER+ patients the predicted number of events at 10 years increased from 196 for v2 to 204 for v3 compared to 221 observed. The area under the ROC curve (AUC) improved from 0.7611 to 0.7676 (p=0.005) in ER+ patients and from 0.7546 to 0.7595 (p=0.0008) in all 1726 patients (ER+ and ER-).Conclusion: Addition of KI67 to PREDICT has led to a statistically significant improvement in the model performance for ER+ patients and will aid clinical decision making in these patients. Further studies should determine whether other markers including gene expression profiling provide additional prognostic information to that provided by PREDICT. SN - 1471-2407 AD - Department of Oncology, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge CB1 8RN, UK U2 - PMID: 25472026. DO - 10.1186/1471-2407-14-908 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109771669&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104011050 T1 - Development of a personalized decision aid for breast cancer risk reduction and management. AU - Ozanne, Elissa M AU - Howe, Rebecca AU - Omer, Zehra AU - Esserman, Laura J Y1 - 2014/01// N1 - Accession Number: 104011050. Language: English. Entry Date: 20150508. Revision Date: 20170508. Publication Type: journal article; research. Journal Subset: Biomedical; Computer/Information Science; Europe; UK & Ireland. Special Interest: Informatics. Grant Information: R21CA141097/CA/NCI NIH HHS/United States. NLM UID: 101088682. KW - Breast Neoplasms -- Prevention and Control KW - Decision Making KW - Decision Support Systems, Clinical -- Standards KW - Decision Support Techniques KW - Adult KW - Aged KW - Breast Neoplasms -- Therapy KW - Decision Support Systems, Clinical -- Equipment and Supplies KW - Disease Management KW - Female KW - Focus Groups KW - Human KW - Internet -- Utilization KW - Male KW - Middle Age KW - Patient Centered Care -- Standards KW - Risk Assessment KW - Behavior SP - 4 EP - 4 JO - BMC Medical Informatics & Decision Making JF - BMC Medical Informatics & Decision Making JA - BMC MED INFORM DECIS MAKING VL - 14 IS - 1 PB - BioMed Central AB - Background: Breast cancer risk reduction has the potential to decrease the incidence of the disease, yet remains underused. We report on the development a web-based tool that provides automated risk assessment and personalized decision support designed for collaborative use between patients and clinicians.Methods: Under Institutional Review Board approval, we evaluated the decision tool through a patient focus group, usability testing, and provider interviews (including breast specialists, primary care physicians, genetic counselors). This included demonstrations and data collection at two scientific conferences (2009 International Shared Decision Making Conference, 2009 San Antonio Breast Cancer Symposium).Results: Overall, the evaluations were favorable. The patient focus group evaluations and usability testing (N = 34) provided qualitative feedback about format and design; 88% of these participants found the tool useful and 94% found it easy to use. 91% of the providers (N = 23) indicated that they would use the tool in their clinical setting.Conclusion: BreastHealthDecisions.org represents a new approach to breast cancer prevention care and a framework for high quality preventive healthcare. The ability to integrate risk assessment and decision support in real time will allow for informed, value-driven, and patient-centered breast cancer prevention decisions. The tool is being further evaluated in the clinical setting. SN - 1472-6947 AD - Department of Surgery, Institute for Health Policy Studies, University of California at San Francisco, San Francisco, CA, USA. elissa.m.ozanne@dartmouth.edu. U2 - PMID: 24422989. DO - 10.1186/1472-6947-14-4 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104011050&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 109728138 T1 - Enablers and barriers to using patient decision aids in early stage breast cancer consultations: a qualitative study of surgeons' views. AU - O'Brien, Mary Ann AU - Charles, Cathy AU - Lovrics, Peter AU - Wright, Frances C AU - Whelan, Tim AU - Simunovic, Marko AU - Kennedy, Erin AU - Grunfeld, Eva Y1 - 2014/01// N1 - Accession Number: 109728138. Language: English. Entry Date: 20150123. Revision Date: 20161117. Publication Type: journal article; research. Journal Subset: Biomedical; Europe; Health Services Administration; UK & Ireland. Grant Information: //Canadian Institutes of Health Research/Canada. NLM UID: 101258411. SP - 174 EP - 174 JO - Implementation Science JF - Implementation Science JA - IMPLEMENT SCI VL - 9 IS - 1 PB - BioMed Central AB - Background: For early stage breast cancer, randomized controlled trials (RCTs) have shown that patient decision aids (PtDAs), when used by surgeons, result in increased patient knowledge about options and different patient treatment choices as compared to standard care. Yet, recent data suggests that PtDAs are used by less than 25% of Canadian cancer physicians. We conducted a study to explore breast cancer surgeons' views on enablers and barriers to the use of PtDAs in their practice.Methods: Purposeful sampling was used to select breast cancer surgeons in three Ontario health regions to participate in semi-structured interviews. Inductive coding and the constant comparative method were used to identify the main themes.Results: Twenty-two surgeons (79%) agreed to participate (median age, 50 years; 9 (40%) female). Surgeons practiced in academic (n = 7, 32%) or community (n = 15, 68%) hospitals. Fourteen surgeons were aware of PtDAs, nine had used a PtDA with patients as part of an RCT, and six had developed their own informal PtDA for use in their practice. Enablers of informal PtDA use included surgeon exposure during training and surgeon perceived need for a systematic approach when communicating risks and benefits of surgical treatments with patients. Barriers to formal PtDA use included high surgeon confidence in their verbal communication skills, surgeon belief that patients understood conveyed information, and difficulties embedding such tools in practice routines.Conclusions: Surgeons in this study valued systematic communication with patients. Several surgeons changed their practice to include formal or informal PtDAs provided they perceived there was a clear benefit to themselves or to patients. However, high surgeon confidence in their personal communications skills coupled with beliefs that patients understand conveyed information may be key barriers to PtDA uptake once surgeons have established communication routines. SN - 1748-5908 U2 - PMID: 25433370. DO - 10.1186/s13012-014-0174-0 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109728138&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104001707 T1 - Guideline-inconsistent breast cancer screening for women over 50: a vignette-based survey. AU - Kadivar, Hajar AU - Goff, Barbara A AU - Phillips, William R AU - Andrilla, C Holly A AU - Berg, Alfred O AU - Baldwin, Laura-Mae Y1 - 2014/01// N1 - Accession Number: 104001707. Language: English. Entry Date: 20140926. Revision Date: 20161117. Publication Type: journal article; research. Journal Subset: Biomedical; Continental Europe; Europe. Grant Information: U48 DP001911/DP/NCCDPHP CDC HHS/United States. NLM UID: 8605834. KW - Breast Neoplasms -- Diagnosis KW - Early Detection of Cancer -- Standards KW - Practice Guidelines KW - Cross Sectional Studies KW - Early Detection of Cancer -- Methods KW - Female KW - Guideline Adherence -- Statistics and Numerical Data KW - Surveys KW - Health Services Research -- Methods KW - Human KW - Magnetic Resonance Imaging -- Utilization KW - Male KW - Mammography -- Standards KW - Mammography -- Utilization KW - Middle Age KW - Physicians, Family -- Psychosocial Factors KW - Physicians, Family -- Standards KW - Physicians, Family -- Statistics and Numerical Data KW - Professional Practice -- Statistics and Numerical Data KW - Risk Assessment -- Methods KW - Risk Taking Behavior KW - Ultrasonography -- Utilization KW - United States KW - Unnecessary Procedures -- Statistics and Numerical Data SP - 82 EP - 89 JO - JGIM: Journal of General Internal Medicine JF - JGIM: Journal of General Internal Medicine JA - J GEN INTERN MED VL - 29 IS - 1 CY - , PB - Springer Science & Business Media B.V. AB - Background: Professional organizations have issued guidelines recommending breast cancer screening for women 50 years of age.Objective: This study examines the percent of U.S. primary care physicians who report breast cancer screening practices that are not consistent with guidelines, and the characteristics of physicians who reported offering extra test modalities.Design: We analyzed a subset of a 2008 cross-sectional Women's Health Care survey sent to primary care physicians randomly selected from the national American Medical Association (AMA) Physician Masterfile. A subset of physicians received a survey that presented a vignette of a health maintenance visit for an asymptomatic 51-year-old woman who was not at high risk for breast cancer. Responses were weighted to represent physicians nationally.Participants: 1,654 U.S. family physicians, general internists, and obstetrician-gynecologists under age 65, who practiced in office or hospital based settings (62.8 % response rate). After exclusions, 553 study physicians remained for analysis.Main Measure: Physician self-report of breast cancer screening practices that are not consistent with the recommendations of the U.S. Preventive Services Task Force (USPSTF), the American College of Obstetrics and Gynecology (ACOG), and the American Cancer Society (ACS), defined as almost always offering mammography.Key Results: 36.0 % (95 % CI: 31.8 %-40.5 %) of physicians reported offering breast cancer screening tests inconsistent with national guidelines, with most offering extra tests (magnetic resonance imaging [MRI] and/or ultrasound) (33.2 %, 95 % CI 29.1 %-37.6 %). In adjusted analysis, risk-averse physicians and those who believed in the clinical effectiveness of MRI were more likely to offer extra breast cancer screening tests.Conclusions: Physicians often report offering breast cancer screening test modalities beyond those recommended for a 51-year-old woman. Strategies, such as academic detailing regarding appropriate use of technology and provision of clinical decision support for breast cancer screening, could decrease overuse of resources. SN - 0884-8734 AD - University of Florida College of Medicine, PO Box 100177, Gainesville, FL, 32610-0177, USA, kadivar@ufl.edu. U2 - PMID: 23943421. DO - 10.1007/s11606-013-2567-1 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104001707&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107941659 T1 - Doctors argue for decision aids to promote patient engagement. AU - Evans, Melanie Y1 - 2013/12/02/ N1 - Accession Number: 107941659. Language: English. Entry Date: 20131209. Revision Date: 20150712. Publication Type: Journal Article; pictorial; tables/charts. Journal Subset: Health Services Administration; USA. NLM UID: 7801798. KW - Decision Making, Clinical KW - Decision Making, Patient KW - Health Care Costs KW - Patient Education KW - Cost Savings KW - Health Knowledge KW - Unnecessary Procedures KW - Patient Protection and Affordable Care Act KW - Prostatic Neoplasms -- Therapy KW - Breast Neoplasms -- Therapy KW - Drug Therapy KW - Patient Compliance SP - 26 EP - 30 JO - Modern Healthcare JF - Modern Healthcare JA - MOD HEALTHC VL - 43 IS - 48 CY - Detroit, Michigan PB - Crain Communications Inc. (MI) SN - 0160-7480 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107941659&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104112352 T1 - Multileaf Collimation Cardiac Shielding in Breast Radiotherapy: Cardiac Doses are Reduced, But at What Cost? AU - Bartlett, F.R. AU - Yarnold, J.R. AU - Donovan, E.M. AU - Evans, P.M. AU - Locke, I. AU - Kirby, A.M. Y1 - 2013/12// N1 - Accession Number: 104112352. Language: English. Entry Date: 20140106. Revision Date: 20150710. Publication Type: Journal Article; diagnostic images; research; tables/charts. Journal Subset: Biomedical; Double Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. Special Interest: Critical Care; Oncologic Care. Grant Information: We acknowledge NHS funding to the NIHR Biomedical Research Centre and the support of the NIHR, through the South London Cancer Research Network.. NLM UID: 9002902. KW - Breast Neoplasms -- Radiotherapy KW - Radiotherapy -- Methods KW - Equipment and Supplies -- Utilization KW - Human KW - Risk Assessment KW - United Kingdom KW - Academic Medical Centers KW - Coronary Vessels -- Injuries KW - Funding Source SP - 690 EP - 696 JO - Clinical Oncology JF - Clinical Oncology JA - CLIN ONCOL VL - 25 IS - 12 CY - Philadelphia, Pennsylvania PB - W B Saunders AB - Abstract: Aims: To measure cardiac tissue doses in left-sided breast cancer patients receiving supine tangential field radiotherapy with multileaf collimation (MLC) cardiac shielding of the heart and to assess the effect on target volume coverage. Materials and methods: Sixty-seven consecutive patients who underwent adjuvant radiotherapy to the left breast (n = 48) or chest wall (n = 19) in 2009/2010 were analysed. The heart, left anterior descending coronary artery (LAD), whole breast and partial breast clinical target volumes (WBCTV and PBCTV) were outlined retrospectively (the latter only in patients who had undergone breast-conserving surgery [BCS]). The mean heart and LAD NTDmean and maximum LAD doses (LADmax) were calculated for all patients (NTDmean is a biologically weighted mean dose normalised to 2 Gy fractions using a standard linear quadratic model). Coverage of WBCTV and PBCTV by the 95% isodose was assessed (BCS patients only). Results: The mean heart NTDmean (standard deviation) was 0.8 (0.3) Gy, the mean LAD NTDmean 6.7 (4.3) Gy and the mean LADmax 40.3 (10.1) Gy. Coverage of the WBCTV by 95% isodose was <90% in one in three patients and PBCTV coverage <95% (range 78–94%) in one in 10 BCS patients. Conclusion: The use of MLC cardiac shielding reduces doses to cardiac tissues at the expense of target tissue coverage. Formal target volume delineation in combination with an assessment of the likelihood of local relapse is recommended in order to aid decisions regarding field and MLC placement. SN - 0936-6555 AD - Department of Academic Radiotherapy, Royal Marsden NHS Foundation Trust, Sutton, UK AD - Department of Academic Radiotherapy, Royal Marsden NHS Foundation Trust, Sutton, UK; Division of Radiotherapy and Imaging, Institute of Cancer Research, Sutton, UK AD - Joint Department of Physics, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, UK AD - Joint Department of Physics, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, UK; Centre for Vision, Speech and Signal Processing, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford, UK U2 - PMID: 24083961. DO - 10.1016/j.clon.2013.09.002 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104112352&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104135886 T1 - The effect of patient narratives on information search in a web-based breast cancer decision aid: an eye-tracking study. AU - Shaffer, Victoria A AU - Owens, Justin AU - Zikmund-Fisher, Brian J Y1 - 2013/12// N1 - Accession Number: 104135886. Language: English. Entry Date: 20140829. Revision Date: 20150710. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Canada; Computer/Information Science; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed. Special Interest: Informatics. NLM UID: 100959882. KW - Breast Neoplasms -- Surgery KW - Decision Support Techniques KW - Internet KW - Telemedicine KW - Adult KW - Aged KW - Breast Neoplasms -- Psychosocial Factors KW - Consumer Participation KW - Decision Making KW - Eye Movements KW - Female KW - Human KW - Information Seeking Behavior KW - Middle Age KW - Random Assignment KW - Videorecording SP - e273 EP - e273 JO - Journal of Medical Internet Research JF - Journal of Medical Internet Research JA - J MED INTERNET RES VL - 15 IS - 12 CY - Toronto, Ontario PB - JMIR Publications Inc. AB - BACKGROUND: Previous research has examined the impact of patient narratives on treatment choices, but to our knowledge, no study has examined the effect of narratives on information search. Further, no research has considered the relative impact of their format (text vs video) on health care decisions in a single study. OBJECTIVE: Our goal was to examine the impact of video and text-based narratives on information search in a Web-based patient decision aid for early stage breast cancer. METHODS: Fifty-six women were asked to imagine that they had been diagnosed with early stage breast cancer and needed to choose between two surgical treatments (lumpectomy with radiation or mastectomy). Participants were randomly assigned to view one of four versions of a Web decision aid. Two versions of the decision aid included videos of interviews with patients and physicians or videos of interviews with physicians only. To distinguish between the effect of narratives and the effect of videos, we created two text versions of the Web decision aid by replacing the patient and physician interviews with text transcripts of the videos. Participants could freely browse the Web decision aid until they developed a treatment preference. We recorded participants' eye movements using the Tobii 1750 eye-tracking system equipped with Tobii Studio software. A priori, we defined 24 areas of interest (AOIs) in the Web decision aid. These AOIs were either separate pages of the Web decision aid or sections within a single page covering different content. RESULTS: We used multilevel modeling to examine the effect of narrative presence, narrative format, and their interaction on information search. There was a significant main effect of condition, P=.02; participants viewing decision aids with patient narratives spent more time searching for information than participants viewing the decision aids without narratives. The main effect of format was not significant, P=.10. However, there was a significant condition by format interaction on fixation duration, P<.001. When comparing the two video decision aids, participants viewing the narrative version spent more time searching for information than participants viewing the control version of the decision aid. In contrast, participants viewing the narrative version of the text decision aid spent less time searching for information than participants viewing the control version of the text decision aid. Further, narratives appear to have a global effect on information search; these effects were not limited to specific sections of the decision aid that contained topics discussed in the patient stories. CONCLUSIONS: The observed increase in fixation duration with video patient testimonials is consistent with the idea that the vividness of the video content could cause greater elaboration of the message, thereby encouraging greater information search. Conversely, because reading requires more effortful processing than watching, reading patient narratives may have decreased participant motivation to engage in more reading in the remaining sections of the Web decision aid. These findings suggest that the format of patient stories may be equally as important as their content in determining their effect on decision making. More research is needed to understand why differences in format result in fundamental differences in information search. SN - 1438-8871 AD - University of Missouri, Department of Health Sciences, School of Health Professions, Department of Psychological Sciences, College of Arts & Science, Columbia, MO, United States. shafferv@health.missouri.edu. U2 - PMID: 24345424. DO - 10.2196/jmir.2784 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104135886&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104111424 T1 - Development of a Decision Aid about fertility preservation for women with breast cancer in the Netherlands. AU - Garvelink, Mirjam M AU - Ter Kuile, Moniek M AU - Fischer, Maarten J AU - Louwé, Leoni A AU - Hilders, Carina G J M AU - Kroep, Judith R AU - Stiggelbout, Anne M Y1 - 2013/12// N1 - Accession Number: 104111424. Language: English. Entry Date: 20140725. Revision Date: 20150710. Publication Type: Journal Article; research. Journal Subset: Biomedical; Europe; UK & Ireland. Special Interest: Obstetric Care. NLM UID: 8308648. KW - Breast Neoplasms -- Surgery KW - Decision Support Techniques KW - Fertility Preservation -- Psychosocial Factors KW - Adult KW - Decision Making KW - Female KW - Human KW - Netherlands KW - Questionnaires KW - Women SP - 170 EP - 178 JO - Journal of Psychosomatic Obstetrics & Gynecology JF - Journal of Psychosomatic Obstetrics & Gynecology JA - J PSYCHOSOM OBSTET GYNAECOL VL - 34 IS - 4 CY - Philadelphia, Pennsylvania PB - Taylor & Francis Ltd SN - 0167-482X AD - Department of Gynecology, Leiden University Medical Center (LUMC) , Leiden , the Netherlands . U2 - PMID: 24188788. DO - 10.3109/0167482X.2013.851663 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104111424&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104121436 T1 - Performance goals for an adjunct diagnostic test to reduce unnecessary biopsies after screening mammography: analysis of costs, benefits, and consequences. AU - Lee, Christoph I AU - Bensink, Mark E AU - Berry, Kristin AU - Musa, Zahra AU - Bodnar, Carolyn AU - Dann, Robert AU - Jarvik, Jeffrey G AU - Lehman, Constance D AU - Ramsey, Scott D Y1 - 2013/12// N1 - Accession Number: 104121436. Language: English. Entry Date: 20140815. Revision Date: 20150710. Publication Type: Journal Article; research. Journal Subset: Biomedical; Double Blind Peer Reviewed; Peer Reviewed; USA. Special Interest: Diagnostic Imaging. NLM UID: 101190326. KW - Biopsy -- Economics KW - Breast Neoplasms -- Diagnosis KW - Breast Neoplasms -- Economics KW - Decision Support Techniques KW - Early Detection of Cancer KW - Mammography -- Economics KW - Unnecessary Procedures -- Economics KW - Adult KW - Aged KW - Biopsy -- Utilization KW - Breast Neoplasms -- Prevention and Control KW - Cost Benefit Analysis -- Economics KW - Cost Benefit Analysis -- Methods KW - Female KW - Health Care Costs -- Statistics and Numerical Data KW - Human KW - Mammography -- Utilization KW - Middle Age KW - Patient Care Plans -- Economics KW - Reproducibility of Results KW - Sensitivity and Specificity KW - United States KW - Unnecessary Procedures -- Utilization KW - Washington SP - 924 EP - 930 JO - Journal of the American College of Radiology JF - Journal of the American College of Radiology JA - J AM COLL RADIOL VL - 10 IS - 12 CY - New York, New York PB - Elsevier B.V. AB - PURPOSE: Because benign biopsies resulting from false-positive mammographic findings are a known harm of breast cancer screening, physicians and test manufacturers are searching for ways to reduce their frequency. The aim of this study was to estimate potential costs and consequences associated with using an adjunct diagnostic test for triaging women with suspicious mammographic findings before biopsy. METHODS: A decision model was developed to compare the use of an adjunct test before biopsy to the current standard of care for suspicious mammographic findings. The decision analysis was performed from the perspective of a national health payer, with a 1-year time horizon among women representative of the US screening population aged 40 to 79 years. Three primary outcomes were assessed: (1) incremental costs, (2) number of benign biopsies avoided, and (3) number of missed opportunities for diagnosing cancer per million women screened. Input parameters were obtained from the medical literature and expert opinion. Sensitivity analyses were performed to evaluate the effects of uncertainty in parameter estimates. RESULTS: The base-case analysis demonstrated that the use of an adjunct diagnostic test with 95% sensitivity, 75% specificity, and a cost of $1,000 would eliminate 8,127 unnecessary breast biopsies per million women screened. However, this would cost the US health care system an additional $6,462,977 and result in 255 missed opportunities for diagnosing cancer per million women screened. CONCLUSIONS: The addition of an adjunct test for triaging women for breast biopsy after abnormal findings on screening mammography would likely eliminate many unnecessary biopsies but also increase overall health care costs. This exploratory analysis highlights the fact that mammography remains a relatively inexpensive and effective breast cancer screening and diagnostic modality. SN - 1546-1440 AD - Department of Radiology, University of Washington School of Medicine, Seattle, Washington; Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle, Washington; Department of Health Services, University of Washington School of Public Health, Seattle, Washington. Electronic address: stophlee@uw.edu. U2 - PMID: 24295942. DO - 10.1016/j.jacr.2013.09.009 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104121436&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104117349 T1 - Risk analysis of early implant loss after immediate breast reconstruction: a review of 14,585 patients. AU - Fischer, John P AU - Wes, Ari M AU - Tuggle 3rd, Charles T AU - Serletti, Joseph M AU - Wu, Liza C Y1 - 2013/12// N1 - Accession Number: 104117349. Language: English. Entry Date: 20140124. Revision Date: 20150710. Publication Type: Journal Article; research. Journal Subset: Biomedical; USA. Special Interest: Perioperative Care. NLM UID: 9431305. KW - Breast Implants -- Equipment and Supplies KW - Breast Implants KW - Decision Support Techniques KW - Prosthesis Failure -- Etiology KW - Adult KW - Resource Databases KW - Female KW - Prospective Studies KW - Human KW - Logistic Regression KW - Mastectomy KW - Middle Age KW - Multivariate Analysis KW - Odds Ratio KW - Outcome Assessment KW - Risk Assessment KW - Risk Factors SP - 983 EP - 990 JO - Journal of the American College of Surgeons JF - Journal of the American College of Surgeons JA - J AM COLL SURG VL - 217 IS - 6 CY - New York, New York PB - Elsevier B.V. SN - 1072-7515 AD - Divisions of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA. Electronic address: John.Fischer2@uphs.upenn.edu. U2 - PMID: 23973103. DO - 10.1016/j.jamcollsurg.2013.07.389 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104117349&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104112223 T1 - Managing brain metastases patients with and without radiotherapy: initial lessonsfrom a team-based consult service through a multidisciplinary integrated palliative oncology clinic. AU - Jung, Hellen AU - Sinnarajah, Aynharan AU - Enns, Bert AU - Voroney, Jon-Paul AU - Murray, Alison AU - Pelletier, Guy AU - Wu, Jackson Sai-Yiu Y1 - 2013/12// N1 - Accession Number: 104112223. Language: English. Entry Date: 20150522. Revision Date: 20171020. Publication Type: journal article. Journal Subset: Biomedical; Continental Europe; Double Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed. Special Interest: Oncologic Care. NLM UID: 9302957. KW - Brain Neoplasms -- Radiotherapy KW - Brain Neoplasms KW - Palliative Care -- Methods KW - Multidisciplinary Care Team KW - Adult KW - Aged KW - Aged, 80 and Over KW - Breast Neoplasms -- Pathology KW - Breast Neoplasms -- Radiotherapy KW - Carcinoma, Non-Small-Cell Lung -- Pathology KW - Carcinoma, Non-Small-Cell Lung -- Radiotherapy KW - Decision Making KW - Female KW - Lung Neoplasms -- Pathology KW - Lung Neoplasms -- Radiotherapy KW - Male KW - Middle Age KW - Prognosis KW - Referral and Consultation KW - Terminal Care SP - 3379 EP - 3386 JO - Supportive Care in Cancer JF - Supportive Care in Cancer JA - SUPPORT CARE CANCER VL - 21 IS - 12 CY - , PB - Springer Science & Business Media B.V. AB - Purpose: A new ambulatory consultative clinic with integrated assessments by palliative care, radiation oncology, and allied health professionals was introduced to (1) assess patients with brain metastases at a regional comprehensive cancer center and (2) inform and guide patients on management strategies, including palliative radiotherapy, symptom control, and end-of-life care issues. We conducted a quality assurance study to inform clinical program development.Methods: Between January 2011 and May 2012, 100 consecutive brain metastases patients referred and assessed through a multidisciplinary clinic were evaluated for baseline characteristics, radiotherapy use, and supportive care decisions. Overall survival was examined by known prognostic groups. Proportion of patients receiving end-of-life radiotherapy (death within 30 and 14 days of brain radiotherapy) was used as a quality metric.Results: The median age was 65 years, with non-small cell lung cancer (n = 38) and breast cancer (n = 23) being the most common primary cancers. At least 57 patients were engaged in advance care planning discussions at first consult visit. In total, 75 patients eventually underwent brain radiotherapy, whereas 25 did not. The most common reasons for nonradiotherapy management were patient preference and rapid clinical deterioration. Overall survival for prognostic subgroups was consistent with literature reports. End-of-life brain radiotherapy was observed in 9 % (death within 30 days) and 1 % (within 14 days) of treated patients.Conclusions: By integrating palliative care expertise to address the complex needs of patients with newly diagnosed brain metastases, end-of-life radiotherapy use appears acceptable and improved over historical rates at our institution. An appreciable proportion of patients are not suitable for palliative brain radiotherapy or opt against this treatment option, but the team approach involving nurses, palliative care experts, allied health, and clinical oncologists facilitates patient-centered decision making and transition to end-of-life care. SN - 0941-4355 AD - Department of Nursing, Tom Baker Cancer Centre, Alberta Health Services Cancer Care, Calgary, Canada. U2 - PMID: 23934224. DO - 10.1007/s00520-013-1917-1 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104112223&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104108489 T1 - Routine Histopathologic Characteristics Can Predict Oncotype DX(TM) Recurrence Score in Subsets of Breast Cancer Patients. AU - Mattes, Malcolm D AU - Mann, Justin M AU - Ashamalla, Hani AU - Tejwani, Ajay Y1 - 2013/11// N1 - Accession Number: 104108489. Language: English. Entry Date: 20140131. Revision Date: 20150710. Publication Type: Journal Article; research. Journal Subset: Biomedical; Europe; UK & Ireland. Special Interest: Oncologic Care. NLM UID: 8307154. KW - Breast Neoplasms KW - Decision Support Techniques KW - Genetic Screening KW - Analysis of Variance KW - Biopsy KW - Female KW - Human KW - Immunohistochemistry KW - Neoplasm Metastasis KW - Prognosis KW - Predictive Value of Tests KW - Receptors, Cell Surface -- Analysis KW - Proteins -- Analysis KW - Risk Factors KW - Body Weights and Measures KW - Tumor Markers, Biological -- Analysis SP - 604 EP - 606 JO - Cancer Investigation JF - Cancer Investigation JA - CANCER INVEST VL - 31 IS - 9 CY - Philadelphia, Pennsylvania PB - Taylor & Francis Ltd SN - 0735-7907 AD - Radiation Oncology Department, NY Methodist Hospital, Weill Medical College of Cornell University, Brooklyn, New York, USA,1. U2 - PMID: 24164299. DO - 10.3109/07357907.2013.849725 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104108489&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104111050 T1 - Comparison of Oncotype DX and Mammostrat risk estimations and correlations with histologic tumor features in low-grade, estrogen receptor-positive invasive breast carcinomas. AU - Acs, Geza AU - Kiluk, John AU - Loftus, Loretta AU - Laronga, Christine Y1 - 2013/11// N1 - Accession Number: 104111050. Language: English. Entry Date: 20140704. Revision Date: 20150710. Publication Type: Journal Article; research. Journal Subset: Biomedical; USA. Special Interest: Laboratory Diagnosis. NLM UID: 8806605. KW - Breast Neoplasms KW - Decision Support Techniques KW - Gene Expression Profiling KW - Genetic Screening -- Methods KW - Immunohistochemistry KW - Proteins -- Analysis KW - Tumor Markers, Biological -- Analysis KW - Tumor Markers, Biological KW - Cell Physiology KW - Female KW - Human KW - Inflammation KW - Inflammation -- Metabolism KW - Middle Age KW - Prognosis KW - Neoplasm Invasiveness KW - Patient Selection KW - Predictive Value of Tests KW - Risk Assessment KW - Risk Factors KW - Connective Tissue Cells KW - Connective Tissue Cells -- Pathology SP - 1451 EP - 1460 JO - Modern Pathology JF - Modern Pathology JA - MOD PATHOL VL - 26 IS - 11 CY - London, PB - Nature Publishing Group SN - 0893-3952 AD - 1] Department of Anatomic Pathology, Comprehensive Breast Program, Moffitt Cancer Center, Tampa, FL, USA [2] Department of Women's Oncology, Comprehensive Breast Program, Moffitt Cancer Center, Tampa, FL, USA [3] Women's Pathology Consultants, Ruffolo Hooper and Associates, Tampa, FL, USA. U2 - PMID: 23743933. DO - 10.1038/modpathol.2013.88 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104111050&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104105349 T1 - The effects of process-focused versus experience-focused narratives in a breast cancer treatment decision task. AU - Shaffer, Victoria A AU - Hulsey, Lukas AU - Zikmund-Fisher, Brian J Y1 - 2013/11// N1 - Accession Number: 104105349. Language: English. Entry Date: 20140905. Revision Date: 20150710. Publication Type: Journal Article; research; randomized controlled trial. Journal Subset: Core Nursing; Europe; Health Promotion/Education; Nursing; Peer Reviewed; UK & Ireland. NLM UID: 8406280. KW - Breast Neoplasms -- Psychosocial Factors KW - Breast Neoplasms -- Surgery KW - Decision Making KW - Narratives KW - Decision Support Techniques KW - Female KW - Human KW - Information Seeking Behavior KW - Mastectomy -- Psychosocial Factors KW - Lumpectomy -- Psychosocial Factors KW - Middle Age KW - Patient Satisfaction KW - United States KW - Videorecording SP - 255 EP - 264 JO - Patient Education & Counseling JF - Patient Education & Counseling JA - PATIENT EDUC COUNS VL - 93 IS - 2 PB - Elsevier B.V. AB - OBJECTIVE: To examine the effect of patient narratives that discuss decision processes versus patient experiences on decisions about treatments for early stage breast cancer. METHODS: We recruited 300 women with no previous history of breast cancer to imagine that they had been diagnosed with early stage breast cancer and to choose between mastectomy and lumpectomy with radiation. Before learning about their treatment options, participants were randomly assigned to one of four conditions with videotaped stories from fictitious cancer survivors, using a 2 (content: experience versus process)x2 (emotional valence: positive only vs. positive and negative) factorial design, or a control condition with no stories. We measured information search, treatment intentions, and decision satisfaction. RESULTS: Participants viewing process narratives spent more time searching for information. Participants viewing experience narratives reported a greater ability to imagine what it was like to experience the treatments; they also evaluated their decision more positively on several dimensions. CONCLUSIONS: Process narratives appeared to guide information search, and experience narratives improved evaluations of the decision process. PRACTICE IMPLICATIONS: There is no evidence that process and experience narratives 'bias' decisions in the same manner as outcome narratives. Further, their potential to focus patient attention on key information and increase patient confidence in decision making appears significant. SN - 0738-3991 AD - Department of Health Sciences and Department of Psychological Sciences, University of Missouri, Columbia, USA. Electronic address: shafferv@health.missouri.edu. U2 - PMID: 23962673. DO - 10.1016/j.pec.2013.07.013 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104105349&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104106766 T1 - Anxiety, depression and defense mechanisms associated with treatment decisional preferences and quality of life in non-metastatic breast cancer: a 1-year prospective study. AU - Hyphantis, Thomas AU - Almyroudi, Augoustina AU - Paika, Vassiliki AU - Degner, Lesley F AU - Carvalho, André F AU - Pavlidis, Nicholas Y1 - 2013/11// N1 - Accession Number: 104106766. Language: English. Entry Date: 20140502. Revision Date: 20150710. Publication Type: Journal Article; research. Journal Subset: Biomedical; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care; Psychiatry/Psychology. Instrumentation: Center for Epidemiologic Studies Depression Scale (CES-D); World Health Organization Quality of Life Measure Abbreviated Version (WHOQOL-BREF); State-Trait Anxiety Inventory (STAI)(Spielberger); Life Style Index. NLM UID: 9214524. KW - Anxiety -- Psychosocial Factors KW - Breast Neoplasms -- Psychosocial Factors KW - Defense Mechanisms KW - Depression -- Psychosocial Factors KW - Quality of Life -- Psychosocial Factors KW - Academic Medical Centers KW - Adult KW - Aged KW - Clinical Assessment Tools KW - Decision Making KW - Female KW - Greece KW - Human KW - Middle Age KW - Patient Satisfaction KW - Prospective Studies KW - Psychological Tests KW - Questionnaires KW - Regression KW - Severity of Illness Indices KW - Sickness Impact Profile KW - Socioeconomic Factors KW - Stress, Psychological -- Psychosocial Factors SP - 2470 EP - 2477 JO - Psycho-Oncology JF - Psycho-Oncology JA - PSYCHO ONCOL VL - 22 IS - 11 CY - Hoboken, New Jersey PB - John Wiley & Sons, Inc. AB - OBJECTIVE: Treatment decisional preferences impact breast cancer patients' health-related quality of life (HRQoL) and may relate to psychological variables, although many aspects of this relationship remain unknown. This prospective study aimed to assess psychological correlates of treatment decisional preferences and predictors of HRQoL in women with early non-metastatic breast cancer. METHODS: Of the 124 women initially assessed for anxiety (Spielberger's State-Trait Anxiety Inventory) and depressive (Center for Epidemiologic Studies-Depression (CES-D)) symptoms, HRQoL (WHOQOL-BREF), and defense mechanisms (Life Style Index), 82 (66.1%) completed the 1-year follow-up. Mean age was 54.6 years (SD = 9.76), and mean disease duration was 19.4 months (SD = 25.55); 19.5% had stage I, 63.4% stage II and 17.1% stage III disease. The predictive power and moderator effects of psychological variables were tested using multiple and hierarchical regression models. RESULTS: Depressive symptoms and physical HRQoL improved significantly, state anxiety and mental and environment HRQoL remained stable, and social relations HRQoL deteriorated over the 1-year period. Older age (p = 0.021) and higher scores in repression defense (p = 0.044) were independently associated with passive decisional preferences. Earlier stage of cancer (p = 0.043), lower state anxiety (p = 0.039), lower repression scores (p = 0.021) and improvement in depressive symptoms (p < 0.001) predicted physical HRQoL improvement. Moderation analysis showed that active decisional preferences predicted physical HRQoL improvement, but only in those women with lower repression levels. CONCLUSIONS: Defense mechanisms are associated with treatment decisional preferences and interact with factors predicting HRQoL in women with breast cancer. Clinicians should address the patients' anxiety and depressive symptoms and refer patients with high repression tendencies for psychological evaluation and management. Copyright © 2013 John Wiley & Sons, Ltd. SN - 1057-9249 AD - Department of Psychiatry, Medical School, University of Ioannina, Greece. U2 - PMID: 23712915. DO - 10.1002/pon.3308 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104106766&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104110173 T1 - Which Patients may benefit from the Use of a Decision Support System to Improve Compliance of Physician Decisions with Clinical Practice Guidelines: A Case Study with Breast Cancer involving Data Mining. AU - Séroussi, Brigitte AU - Soulet, Arnaud AU - Spano, Jean-Philippe AU - Lefranc, Jean-Pierre AU - Cojean-Zelek, Isabelle AU - Blaszka-Jaulerry, Brigitte AU - Zelek, Laurent AU - Durieux, Axel AU - Tournigand, Christophe AU - Messai, Nizar AU - Rousseau, Alexandra AU - Bouaud, Jacques Y1 - 2013/10// N1 - Accession Number: 104110173. Language: English. Entry Date: 20140213. Revision Date: 20150710. Publication Type: Journal Article; equations & formulas; research; tables/charts. Journal Subset: Computer/Information Science; Continental Europe; Editorial Board Reviewed; Europe; Peer Reviewed. Special Interest: Informatics; Oncologic Care. NLM UID: 9214582. KW - Decision Support Systems, Clinical KW - Patient Selection KW - Decision Making, Clinical KW - Guideline Adherence KW - Breast Neoplasms KW - Data Mining KW - Human KW - Case Studies SP - 534 EP - 538 JO - Studies in Health Technology & Informatics JF - Studies in Health Technology & Informatics JA - STUD HEALTH TECHNOL INFORM VL - 192 PB - IOS Press SN - 0926-9630 AD - UPMC, UFR de Médecine, Sorbonne Universités, Paris, France; AP-HP, Hôpital Tenon, Département de santé publique, Paris, France; Université Paris 13, Sorbonne Paris Cité, LIM&BIO EA3969, Bobigny, France; APREC, Paris, France AD - Université François Rabelais Tours, Laboratoire Informatique EA 6300, Tours, France AD - UPMC, UFR de Médecine, Sorbonne Universités, Paris, France; AP-HP, Hôpital Pitié-Salpétrière, Service d'Oncologie médicale, Paris, France AD - UPMC, UFR de Médecine, Sorbonne Universités, Paris, France; AP-HP, Hôpital Pitié-Salpétrière, Service de Chirurgie et Cancérologie gynécologique et mammaire, Paris, France AD - Hôpital des Diaconesses, Pôle oncologie médicale, Paris, France AD - CH Lagny Marne la Vallée, Service de Radiothérapie-Oncologie, Lagny, France AD - Université Paris 13, UFR SMBH, Bobigny, France; AP-HP, Hôpital Avicenne, Service d'oncologie médicale, Bobigny, France AD - Institut de Cancérologie des Peupliers, Paris, France AD - AP-HP, Hôpital St-Antoine, Service d'oncologie médicale, Paris, France AD - AP-HP, Hôpital St-Antoine, URC-EST, Paris, France AD - AP-HP, DRCD, Paris, France; INSERM UMR_S 872 eq. 20, CRC, Paris, France U2 - PMID: 23920612. DO - 10.3233/978-1-61499-289-9-534 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104110173&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104221342 T1 - Which breast cancer decisions remain non-compliant with guidelines despite the use of computerised decision support? AU - Séroussi, B AU - Laouénan, C AU - Gligorov, J AU - Uzan, S AU - Mentré, F AU - Bouaud, J Y1 - 2013/09/03/ N1 - Accession Number: 104221342. Language: English. Entry Date: 20131129. Revision Date: 20150711. Publication Type: Journal Article. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care. NLM UID: 0370635. KW - Breast Neoplasms -- Diagnosis KW - Breast Neoplasms -- Therapy KW - Decision Support Techniques KW - Guideline Adherence KW - Practice Patterns -- Standards KW - Adult KW - Aged KW - Aged, 80 and Over KW - Decision Making, Computer Assisted KW - Expert Systems KW - Female KW - Middle Age SP - 1147 EP - 1156 JO - British Journal of Cancer JF - British Journal of Cancer JA - BR J CANCER VL - 109 IS - 5 CY - London, PB - Nature Publishing Group SN - 0007-0920 AD - 1] UPMC, UFR de Médecine, Sorbonne Universités, 91 boulevard de l'hôpital, 75013 Paris, France [2] AP-HP, Hôpital Tenon, Département de Santé Publique, 4 rue de la Chine, 75020 Paris, France [3] Université Paris 13, Sorbonne Paris Cité, LIM&BIO EA3969, 74 rue Marcel Cachin, 93000 Bobigny, France [4] APREC, 4 rue de la Chine, 75020 Paris, France. U2 - PMID: 23942076. DO - 10.1038/bjc.2013.453 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104221342&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104035926 T1 - Decision aids for breast cancer chemoprevention. AU - Juraskova, Ilona AU - Bonner, Carissa Y1 - 2013/09// N1 - Accession Number: 104035926. Language: English. Entry Date: 20140926. Revision Date: 20150710. Publication Type: Journal Article; editorial. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care. NLM UID: 100927353. KW - Breast Neoplasms -- Prevention and Control KW - Decision Making KW - Decision Support Techniques KW - Consent KW - Internet KW - Premedication KW - Selective Estrogen Receptor Modulators -- Administration and Dosage KW - Female SP - 106 EP - 106 JO - Breast Cancer Research JF - Breast Cancer Research JA - BREAST CANCER RES VL - 15 IS - 2 PB - BioMed Central AB - The article by Korfage and colleagues in this issue of Breast Cancer Research highlights the importance of enabling women to make informed choices about breast cancer chemoprevention. Decision aids have the potential to improve knowledge and decision-making in this context, but they do not guarantee increased uptake of chemoprevention amongst high-risk women if this option is inconsistent with women's values. Important avenues for further research in this area include evaluating: decision aids with explicit values clarification exercises and with comparison between chemoprevention and nonpharmacological options to reduce breast cancer risk, the influence of mediating factors such as anxiety and risk perception, and the role of clinicians and family members in decision-making. SN - 1465-5411 U2 - PMID: 24050596. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104035926&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104035940 T1 - Informed choice about breast cancer prevention: randomized controlled trial of an online decision aid intervention. AU - Korfage, Ida J AU - Fuhrel-Forbis, Andrea AU - Ubel, Peter A AU - Zikmund-Fisher, Brian J AU - Greene, Sarah M AU - McClure, Jennifer B AU - Smith, Dylan M AU - Alford, Sharon Hensley AU - Fagerlin, Angela Y1 - 2013/09// N1 - Accession Number: 104035940. Language: English. Entry Date: 20140926. Revision Date: 20161222. Publication Type: journal article; research; randomized controlled trial. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care. Grant Information: P50 CA101451/CA/NCI NIH HHS/United States. NLM UID: 100927353. KW - Breast Neoplasms -- Prevention and Control KW - Consent KW - Decision Making KW - Decision Support Techniques KW - Internet KW - Premedication KW - Selective Estrogen Receptor Modulators -- Administration and Dosage KW - Adult KW - Aged KW - Attitude to Health KW - Chemoprevention KW - Female KW - Human KW - Middle Age KW - Prospective Studies KW - Raloxifene -- Administration and Dosage KW - Randomized Controlled Trials KW - Risk Factors KW - Tamoxifen -- Administration and Dosage SP - R74 EP - R74 JO - Breast Cancer Research JF - Breast Cancer Research JA - BREAST CANCER RES VL - 15 IS - 2 PB - BioMed Central AB - Introduction: Tamoxifen and raloxifene are chemopreventive drugs that can reduce women’s relative risk of primary breast cancer by 50%; however, most women eligible for these drugs have chosen not to take them. The reasons for low uptake may be related to women’s knowledge or attitudes towards the drugs. We aimed to examine the impact of an online breast cancer chemoprevention decision aid (DA) on informed intentions and decisions of women at high risk of breast cancer.Methods: We conducted a randomized clinical trial, assessing the effect of a DA about breast cancer chemoprevention on informed choices about chemoprevention. Women (n = 585), 46- to 74-years old old, completed online baseline, post-test, and three-month follow-up questionnaires. Participants were randomly assigned to either an intervention group, a standard control group that answered questions about chemoprevention at baseline, or a three-month control group that did not answer questions about chemoprevention at baseline. The main outcome measures were whether women’s intentions and decisions regarding chemoprevention drugs were informed, and whether women who viewed the DA were more likely to make informed decisions than women who did not view the DA, using a dichotomous composite variable ‘informed choice’ (yes/no) to classify informed decisions as those reflecting sufficient knowledge and concordance between a woman’s decision and relevant attitudes.Results: Analyses showed that more intervention than standard control participants (52.7% versus 5.9%) made informed decisions at post-test, P <0.001. At the three-month follow-up, differences in rates of informed choice between intervention (16.9%) and both control groups (11.8% and 8.0%) were statistically non-significant, P = 0.067.Conclusions: The DA increased informed decision making about breast cancer chemoprevention, although the impact on knowledge diminished over time. This study was not designed to determine how much knowledge decision makers must retain over time. Examining informed decisions increases understanding of the impact of DAs. A standard for defining and measuring sufficient knowledge for informed decisions is needed.Trial Registration: ClinicalTrials.gov: NCT00967824 SN - 1465-5411 U2 - PMID: 24004815. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104035940&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107897155 T1 - L'intention du personnel infirmier de favoriser la prise de décision éclairée en matière de dépistage du cancer du sein par mammographie. AU - Ndoh Kiyang, Lawrence AU - Labrecque, Michel AU - Doualla-Bell, Florence AU - Turcotte, Stéphane AU - Roch, Geneviève AU - Farley, Céline AU - Cionti Bas, Myrtha AU - Légaré, France Y1 - 2013/09// N1 - Accession Number: 107897155. Language: English. Entry Date: 20140411. Revision Date: 20150712. Publication Type: Journal Article; research; tables/charts. Journal Subset: Canada; Core Nursing; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Nursing; Peer Reviewed. Special Interest: Oncologic Care; Women's Health. Grant Information: Institut National de Sante Publique du Quebec. NLM UID: 8910581. KW - Cancer Screening KW - Breast Neoplasms -- Radiography KW - Decision Making, Patient KW - Breast Neoplasms -- Prevention and Control KW - Human KW - Surveys KW - Intention KW - Support, Psychosocial KW - Registered Nurses KW - Quebec KW - Questionnaires KW - Summated Rating Scaling KW - Ajzen's Theory of Planned Behavior KW - Female KW - Middle Age KW - Aged KW - Descriptive Statistics KW - Confidence Intervals KW - Spearman's Rank Correlation Coefficient KW - Multivariate Analysis KW - Logistic Regression KW - Data Analysis Software KW - Community Health Nursing KW - Office Nursing KW - Odds Ratio KW - Funding Source SP - 136 EP - 152 JO - Canadian Journal of Nursing Research JF - Canadian Journal of Nursing Research JA - CAN J NURS RES VL - 45 IS - 3 CY - Thousand Oaks, California PB - Sage Publications Inc. AB - There is growing interest in informed decision-making about breast cancer screening with mammography and growing advocacy for the provision of balanced information about potential benefits and harms.The authors report on a survey evaluating nurses' intention to support women targeted by the Quebec Breast Cancer Screening Program in making informed decisions about breast cancer screening with mammography. Of the 840 questionnaires completed, 618 were included in the data analysis.The mean ± standard deviation score for intention was 1.7 ± 1.2 on a 6-point Likert scale ranging from -3 to +3, indicating strong intention to support the targeted women. Perceived behavioural control was the theory-based variable most strongly associated with intention, followed by attitude and social norm.These results can be used to develop interventions to train nurses in integrating informed decision-making about breast cancer screening with mammography into their practice and to design relevant decision support tools. SN - 0844-5621 AD - Professor, Department of Family and Emergency Medicine, Université Laval, Quebec City AD - Biostatistician, Centre hospitalier universitaire de Québec Research Centre, Hôpital Saint-François d'Assise AD - Associate Professor, Faculty of Nursing, Université Laval AD - Scientific Director, Institut National de Santé Publique du Québec AD - Professor, Department of Family and Emergency Medicine, Université Laval UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107897155&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104225588 T1 - Assessing the potential cost-effectiveness of retesting IHC0, IHC1+, or FISH-negative early stage breast cancer patients for HER2 status. AU - Garrison Jr, Louis P AU - Lalla, Deepa AU - Brammer, Melissa AU - Babigumira, Joseph B AU - Wang, Bruce AU - Perez, Edith A Y1 - 2013/09// N1 - Accession Number: 104225588. Language: English. Entry Date: 20131122. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Oncologic Care. NLM UID: 0374236. KW - Antineoplastic Agents, Combined -- Therapeutic Use KW - Breast Neoplasms -- Drug Therapy KW - Breast Neoplasms -- Economics KW - Decision Support Techniques KW - Immunohistochemistry -- Economics KW - In Situ Hybridization, Fluorescence -- Economics KW - Receptors, Cell Surface -- Metabolism KW - Tumor Markers, Biological -- Metabolism KW - Adult KW - Aged KW - Algorithms KW - Antibodies, Monoclonal -- Therapeutic Use KW - Breast Neoplasms -- Metabolism KW - Breast Neoplasms -- Pathology KW - Cost Benefit Analysis KW - False Negative Results KW - Female KW - Health Care Costs KW - Human KW - Middle Age KW - Neoplasm Staging KW - Patient Attitudes KW - Quality-Adjusted Life Years KW - Sensitivity and Specificity KW - United States SP - 3113 EP - 3122 JO - Cancer (0008543X) JF - Cancer (0008543X) JA - CANCER VL - 119 IS - 17 CY - Hoboken, New Jersey PB - John Wiley & Sons, Inc. SN - 0008-543X AD - VeriTech Corporation, Mercer Island, Washington; University of Washington, Seattle, Washington. U2 - PMID: 23775560. DO - 10.1002/cncr.28196 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104225588&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107920405 T1 - New Geriatric Assessments Aid Cancer-Treatment Decisions. AU - Jancin, Bruce Y1 - 2013/09// N1 - Accession Number: 107920405. Language: English. Entry Date: 20131231. Revision Date: 20150712. Publication Type: Journal Article; brief item. Journal Subset: Health Services Administration; USA. Special Interest: Gerontologic Care; Oncologic Care; Women's Health. Instrumentation: Karnofsky Performance Status Scale (KPS); Blessed Orientation-Memory-Concentration Test; Timed 'Up and Go' Test (TUG). NLM UID: 100898002. KW - Geriatric Assessment -- Evaluation KW - Decision Making, Clinical KW - Breast Neoplasms -- Therapy -- In Old Age KW - Age Factors KW - Aged KW - Research KW - Geriatric Assessment -- Classification KW - Clinical Assessment Tools KW - Karnofsky Performance Status SP - 8 EP - 8 JO - Caring for the Ages JF - Caring for the Ages JA - CARING AGES VL - 14 IS - 9 CY - New York, New York PB - Elsevier B.V. SN - 1526-4114 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107920405&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104086289 T1 - Breast cancer risk prediction model: a nomogram based on common mammographic screening findings. AU - Timmers, J M H AU - Verbeek, A L M AU - Inthout, J AU - Pijnappel, R M AU - Broeders, M J M AU - den Heeten, G J Y1 - 2013/09// N1 - Accession Number: 104086289. Language: English. Entry Date: 20140418. Revision Date: 20170930. Publication Type: journal article; research. Journal Subset: Biomedical; Continental Europe; Double Blind Peer Reviewed; Europe; Peer Reviewed. Special Interest: Diagnostic Imaging. NLM UID: 9114774. KW - Breast Neoplasms -- Diagnosis KW - Mammography -- Methods KW - Age Factors KW - Aged KW - Algorithms KW - Decision Support Techniques KW - Female KW - Human KW - Health Screening -- Methods KW - Middle Age KW - Multivariate Analysis KW - Netherlands KW - Models, Statistical KW - Observer Bias KW - Odds Ratio KW - Predictive Value of Tests KW - Probability KW - ROC Curve KW - Reproducibility of Results KW - Retrospective Design SP - 2413 EP - 2419 JO - European Radiology JF - European Radiology JA - EUR RADIOL VL - 23 IS - 9 CY - , PB - Springer Science & Business Media B.V. AB - Objectives: To develop a prediction model for breast cancer based on common mammographic findings on screening mammograms aiming to reduce reader variability in assigning BI-RADS.Methods: We retrospectively reviewed 352 positive screening mammograms of women participating in the Dutch screening programme (Nijmegen region, 2006-2008). The following mammographic findings were assessed by consensus reading of three expert radiologists: masses and mass density, calcifications, architectural distortion, focal asymmetry and mammographic density, and BI-RADS. Data on age, diagnostic workup and final diagnosis were collected from patient records. Multivariate logistic regression analyses were used to build a breast cancer prediction model, presented as a nomogram.Results: Breast cancer was diagnosed in 108 cases (31 %). The highest positive predictive value (PPV) was found for spiculated masses (96 %) and the lowest for well-defined masses (10 %). Characteristics included in the nomogram are age, mass, calcifications, architectural distortion and focal asymmetry.Conclusion: With our nomogram we developed a tool assisting screening radiologists in determining the chance of malignancy based on mammographic findings. We propose cutoff values for assigning BI-RADS in the Dutch programme based on our nomogram, which will need to be validated in future research. These values can easily be adapted for use in other screening programmes.Key Points: • There is substantial reader variability in assigning BI-RADS in mammographic screening. • There are no strict guidelines linking mammographic findings to BI-RADS categories. • We developed a model (nomogram) predicting the presence of breast cancer. • Our nomogram is based on common findings on positive screening mammograms. • The nomogram aims to assist screening radiologists in assigning BI-RADS categories. SN - 0938-7994 AD - National Expert and Training Centre for Breast Cancer Screening, PO Box 6873, 6503 GJ, Nijmegen, The Netherlands, j.timmers@lrcb.nl. U2 - PMID: 23591619. DO - 10.1007/s00330-013-2836-8 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104086289&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104086752 T1 - Discount rates and the education gradient in mammography in the UK. AU - Bíró, Anikó Y1 - 2013/09// N1 - Accession Number: 104086752. Language: English. Entry Date: 20140418. Revision Date: 20170410. Publication Type: journal article. Journal Subset: Europe; Health Services Administration; Peer Reviewed; UK & Ireland. NLM UID: 9306780. KW - Educational Status KW - Mammography -- Utilization KW - Attitude to Health KW - Breast Neoplasms -- Diagnosis KW - Early Detection of Cancer -- Statistics and Numerical Data KW - Early Detection of Cancer -- Utilization KW - Female KW - Great Britain KW - Mammography -- Statistics and Numerical Data KW - Middle Age KW - Models, Theoretical SP - 1021 EP - 1036 JO - Health Economics JF - Health Economics JA - HEALTH ECON VL - 22 IS - 9 CY - Hoboken, New Jersey PB - John Wiley & Sons, Inc. AB - I analyse intertemporal decisions on undertaking breast cancer screening by women aged 50-64  years in the UK and provide estimates of the rate of discounting potential future benefits of screening. I also analyse education differences in mammography decisions and examine the underlying mechanisms by which education influences breast cancer screening attendance. I estimate a structural model, which reveals that although there are differences in the disutility of breast cancer screening between education groups, there is no difference in the estimated discount factor. These results suggest that the observed education gradient is mainly due to differences in health behaviours and healthcare attitudes. SN - 1057-9230 AD - School of Economics, The University of Edinburgh, Edinburgh, UK. U2 - PMID: 23813747. DO - 10.1002/hec.2963 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104086752&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 109859176 T1 - Reducing treatment decision conflict difficulties in breast cancer surgery: a randomized controlled trial. AU - Lam, Wendy W T AU - Chan, Miranda AU - Or, Amy AU - Kwong, Ava AU - Suen, Dacita AU - Fielding, Richard Y1 - 2013/08/10/ N1 - Accession Number: 109859176. Language: English. Entry Date: 20150213. Revision Date: 20150923. Publication Type: Journal Article; research; randomized controlled trial. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Oncologic Care. NLM UID: 8309333. KW - Breast Neoplasms -- Surgery KW - Decision Making KW - Decision Support Techniques KW - Patient Education -- Methods KW - Breast Neoplasms -- Pathology KW - Breast Neoplasms -- Psychosocial Factors KW - Female KW - Human KW - Middle Age KW - Neoplasm Staging KW - Patient Satisfaction KW - Questionnaires KW - Treatment Outcomes SP - 2879 EP - 2885 JO - Journal of Clinical Oncology JF - Journal of Clinical Oncology JA - J CLIN ONCOL VL - 31 IS - 23 CY - Alexandria, Virginia PB - American Society of Clinical Oncology AB - PURPOSE Breast cancer (BC) decision aid (DA) randomized studies are limited to DA use in consultations among Western populations and for primary surgery. Their effectiveness beyond consultations, for reconstructive surgery and in other populations, has not been evaluated. We developed a DA administered after consultation for Chinese women deciding on BC surgery and, where relevant, immediate breast reconstruction, which was evaluated in this randomized controlled trial (RCT). PATIENTS AND METHODS Overall, 276 women considering BC surgery for early-stage BC were randomly assigned to receive a DA (take-home booklet) or the standard information booklet (control condition) after the initial consultation, wherein surgeons disclosed the diagnosis and discussed treatment options with patients. Using block random assignment by week, 138 women were assigned to the DA arm and 138 to the control arm. Participants completed interview-based questionnaires 1 week after consultation and then 1, 4, and 10 months after surgery. Primary outcome measures were decisional conflict, decision-making difficulties, BC knowledge 1 week after consultation, and decision regret 1 month after surgery. Secondary outcome measures were treatment decision, decision regret 4 and 10 months after surgery, and postsurgical anxiety and depression. Results The DA group reported significantly lower decisional conflict scores 1 week after consultation (P = .016) compared with women in the control arm. Women receiving the DA had significantly lower decision regret scores 4 (P = .026) and 10 months (P = .014) after surgery and lower depression scores 10 months after surgery (P = .001). CONCLUSION This RCT demonstrated DAs may benefit Chinese patients in Hong Kong by reducing decisional conflict and subsequent regret and enhance clinical services for this population. SN - 0732-183X AD - Centre for Psycho-Oncological Research and Training, Department of Community Medicine and Unit for Behavioural Sciences, School of Public Health, The University of Hong Kong, 5/F, WMW Mong Block, Faculty of Medicine Building, 21 Sassoon Rd, Pokfulam, Hong Kong; Special Administrative Region, People's Republic of China. wwtlam@hku.hk. U2 - PMID: 23835709. DO - 10.1200/JCO.2012.45.1856 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109859176&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104080256 T1 - A simple and robust classification tree for differentiation between benign and malignant lesions in MR-mammography. AU - Baltzer, Pascal A T AU - Dietzel, Matthias AU - Kaiser, Werner A Y1 - 2013/08// N1 - Accession Number: 104080256. Language: English. Entry Date: 20140307. Revision Date: 20170930. Publication Type: journal article; research. Journal Subset: Biomedical; Continental Europe; Double Blind Peer Reviewed; Europe; Peer Reviewed. Special Interest: Diagnostic Imaging. NLM UID: 9114774. KW - Breast Neoplasms -- Classification KW - Breast Neoplasms -- Diagnosis KW - Decision Trees KW - Magnetic Resonance Imaging -- Methods KW - Mammography -- Methods KW - Adult KW - Aged KW - Algorithms KW - Breast Neoplasms -- Pathology KW - Contrast Media -- Diagnostic Use KW - Diagnosis, Differential KW - Female KW - Human KW - Image Processing, Computer Assisted -- Methods KW - Middle Age KW - Multivariate Analysis KW - Probability KW - ROC Curve KW - Reproducibility of Results SP - 2051 EP - 2060 JO - European Radiology JF - European Radiology JA - EUR RADIOL VL - 23 IS - 8 CY - , PB - Springer Science & Business Media B.V. AB - Objectives: In the face of multiple available diagnostic criteria in MR-mammography (MRM), a practical algorithm for lesion classification is needed. Such an algorithm should be as simple as possible and include only important independent lesion features to differentiate benign from malignant lesions. This investigation aimed to develop a simple classification tree for differential diagnosis in MRM.Methods: A total of 1,084 lesions in standardised MRM with subsequent histological verification (648 malignant, 436 benign) were investigated. Seventeen lesion criteria were assessed by 2 readers in consensus. Classification analysis was performed using the chi-squared automatic interaction detection (CHAID) method. Results include the probability for malignancy for every descriptor combination in the classification tree.Results: A classification tree incorporating 5 lesion descriptors with a depth of 3 ramifications (1, root sign; 2, delayed enhancement pattern; 3, border, internal enhancement and oedema) was calculated. Of all 1,084 lesions, 262 (40.4 %) and 106 (24.3 %) could be classified as malignant and benign with an accuracy above 95 %, respectively. Overall diagnostic accuracy was 88.4 %.Conclusions: The classification algorithm reduced the number of categorical descriptors from 17 to 5 (29.4 %), resulting in a high classification accuracy. More than one third of all lesions could be classified with accuracy above 95 %.Key Points: • A practical algorithm has been developed to classify lesions found in MR-mammography. • A simple decision tree consisting of five criteria reaches high accuracy of 88.4 %. • Unique to this approach, each classification is associated with a diagnostic certainty. • Diagnostic certainty of greater than 95 % is achieved in 34 % of all cases. SN - 0938-7994 AD - Department of Radiology, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria, pascal.baltzer@meduniwien.ac.at. U2 - PMID: 23579418. DO - 10.1007/s00330-013-2804-3 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104080256&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104083013 T1 - Communicating risk of hereditary breast and ovarian cancer with an interactive decision support tool. AU - Rupert, Douglas J AU - Squiers, Linda B AU - Renaud, Jeanette M AU - Whitehead, Nedra S AU - Osborn, Roger J AU - Furberg, Robert D AU - Squire, Claudia M AU - Tzeng, Janice P Y1 - 2013/08// N1 - Accession Number: 104083013. Language: English. Entry Date: 20140307. Revision Date: 20150710. Publication Type: Journal Article; research. Journal Subset: Core Nursing; Europe; Health Promotion/Education; Nursing; Peer Reviewed; UK & Ireland. NLM UID: 8406280. KW - Breast Neoplasms KW - Communication KW - Attitude to Health KW - Ovarian Neoplasms KW - Risk Assessment -- Methods KW - Adult KW - Breast Neoplasms -- Diagnosis KW - Decision Support Systems, Clinical KW - Female KW - Disease Susceptibility KW - Genetic Screening KW - Human KW - Middle Age KW - Ovarian Neoplasms -- Diagnosis KW - Relative Risk KW - Socioeconomic Factors SP - 188 EP - 196 JO - Patient Education & Counseling JF - Patient Education & Counseling JA - PATIENT EDUC COUNS VL - 92 IS - 2 PB - Elsevier B.V. AB - OBJECTIVE: Women with hereditary breast and ovarian cancer syndrome (HBOC) face a higher risk of earlier, more aggressive cancer. Because of HBOC's rarity, screening is recommended only for women with strong cancer family histories. However, most patients do not have accurate history available and struggle to understand genetic concepts. METHODS: Cancer in the Family, an online clinical decision support tool, calculated women's HBOC risk and promoted shared patient-provider decisions about screening. A pilot evaluation (n=9 providers, n=48 patients) assessed the tool's impact on knowledge, attitudes, and screening decisions. Patients used the tool before wellness exams and completed three surveys. Providers accessed the tool during exams, completed exam checklists, and completed four surveys. RESULTS: Patients entered complete family histories (67%), calculated personal risk (96%), and shared risk printouts with providers (65%). HBOC knowledge increased dramatically for patients and providers, and many patients (75%) perceived tool results as valid. The tool prompted patient-provider discussions about HBOC risk and cancer family history (88%). CONCLUSIONS: The tool was effective in increasing knowledge, collecting family history, and sparking patient-provider discussions about HBOC screening. PRACTICE IMPLICATIONS: Interactive tools can effectively communicate personalized risk and promote shared decisions, but they are not a substitute for patient-provider discussions. SN - 0738-3991 AD - Health Communication Program, RTI International, Research Triangle Park, NC, USA. Electronic address: drupert@rti.org. U2 - PMID: 23664232. DO - 10.1016/j.pec.2013.04.008 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104083013&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104083012 T1 - Belief in numbers: When and why women disbelieve tailored breast cancer risk statistics. AU - Scherer, Laura D AU - Ubel, Peter A AU - McClure, Jennifer AU - Greene, Sarah M AU - Alford, Sharon Hensley AU - Holtzman, Lisa AU - Exe, Nicole AU - Fagerlin, Angela Y1 - 2013/08// N1 - Accession Number: 104083012. Language: English. Entry Date: 20140307. Revision Date: 20161119. Publication Type: journal article; research. Journal Subset: Core Nursing; Europe; Health Promotion/Education; Nursing; Peer Reviewed; UK & Ireland. Grant Information: P50 CA101451/CA/NCI NIH HHS/United States. NLM UID: 8406280. KW - Attitude to Health KW - Breast Neoplasms -- Prevention and Control KW - Breast Neoplasms -- Psychosocial Factors KW - Risk Assessment KW - Adult KW - Decision Making KW - Female KW - Human KW - Experimental Studies KW - Middle Age KW - Program Evaluation KW - Risk Factors KW - Women's Health SP - 253 EP - 259 JO - Patient Education & Counseling JF - Patient Education & Counseling JA - PATIENT EDUC COUNS VL - 92 IS - 2 PB - Elsevier B.V. AB - Objective: To examine when and why women disbelieve tailored information about their risk of developing breast cancer.Methods: 690 women participated in an online program to learn about medications that can reduce the risk of breast cancer. The program presented tailored information about each woman's personal breast cancer risk. Half of women were told how their risk numbers were calculated, whereas the rest were not. Later, they were asked whether they believed that the program was personalized, and whether they believed their risk numbers. If a woman did not believe her risk numbers, she was asked to explain why.Results: Beliefs that the program was personalized were enhanced by explaining the risk calculation methods in more detail. Nonetheless, nearly 20% of women did not believe their personalized risk numbers. The most common reason for rejecting the risk estimate was a belief that it did not fully account for personal and family history.Conclusions: The benefits of tailored risk statistics may be attenuated by a tendency for people to be skeptical that these risk estimates apply to them personally.Practice Implications: Decision aids may provide risk information that is not accepted by patients, but addressing the patients' personal circumstances may lead to greater acceptance. SN - 0738-3991 AD - VA Ann Arbor Center for Clinical Management Research, Ann Arbor, USA; Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, USA. Electronic address: schererl@missouri.edu. U2 - PMID: 23623330. DO - 10.1016/j.pec.2013.03.016 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104083012&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107960140 T1 - Decision making in music therapy: The use of a decision tree. AU - Thompson, Stephanie Y1 - 2013/07// N1 - Accession Number: 107960140. Language: English. Entry Date: 20130726. Revision Date: 20150712. Publication Type: Journal Article; tables/charts. Commentary: O'Callaghan Clare. A response to Stephanie Thompson's article, including a tribute to Denise Grocke (AJMT2013 Vol 24) (AUST J MUSIC THER) 2013; 24: 64-66. Journal Subset: Alternative/Complementary Therapies; Australia & New Zealand; Blind Peer Reviewed; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed. NLM UID: 9425712. KW - Music Therapy KW - Decision Trees KW - Decision Making, Clinical KW - Psychotherapy, Group KW - Breast Neoplasms -- Psychosocial Factors KW - Anxiety -- Therapy KW - Depression -- Therapy KW - Support, Psychosocial SP - 48 EP - 64 JO - Australian Journal of Music Therapy JF - Australian Journal of Music Therapy JA - AUST J MUSIC THER VL - 24 PB - Australian Music Therapy Association, Inc. AB - The prescription of decision making within music therapy interventions is a key topic for both clinicians and researchers. Decision trees are graphical representations of problems and are commonly used in the healthcare setting to determine solutions to complex choices. They are efficient and easily interpreted, and assist with finding connections and ultimately potential outcomes to the decisions faced. They are straight-forward to replicate and therefore strengthen the validity of decision making in the therapy or research setting. This article will describe the development and application of a decision tree which was designed for a study of group music therapy for women with breast cancer. Additionally the decision tree provided a framework for determining applicable clinical interventions to meet the needs of participants. Case vignettes from clinical work with women with breast cancer will be used to illustrate the use of this tool. SN - 1036-9457 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107960140&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 109858347 T1 - Decision support system for breast cancer detection using mammograms. AU - Ganesan, Karthikeyan AU - Acharya, Rajendra U AU - Chua, Chua K AU - Min, Lim C AU - Mathew, Betty AU - Thomas, Abraham K Y1 - 2013/07//2013 Jul N1 - Accession Number: 109858347. Language: English. Entry Date: 20150417. Revision Date: 20170411. Publication Type: journal article; research. Journal Subset: Biomedical; Europe; UK & Ireland. NLM UID: 8908934. KW - Breast Neoplasms -- Diagnosis KW - Decision Support Systems, Clinical KW - Diagnosis, Computer Assisted -- Methods KW - Image Interpretation, Computer Assisted -- Methods KW - Mammography -- Methods KW - Adult KW - Aged KW - Breast Neoplasms -- Pathology KW - Breast Neoplasms -- Radiography KW - Resource Databases KW - Female KW - Middle Age KW - Algorithms SP - 721 EP - 732 JO - Proceedings of the Institution of Mechanical Engineers -- Part H -- Journal of Engineering in Medicine (Professional Engineering Publishing) JF - Proceedings of the Institution of Mechanical Engineers -- Part H -- Journal of Engineering in Medicine (Professional Engineering Publishing) JA - PROC INST MECH ENG H VL - 227 IS - 7 CY - Birmingham, Alabama PB - Professional Engineering Publishing AB - Mammograms are by far one of the most preferred methods of screening for breast cancer. Early detection of breast cancer can improve survival rates to a greater extent. Although the analysis and diagnosis of breast cancer are done by experienced radiologists, there is always the possibility of human error. Interobserver and intraobserver errors occur frequently in the analysis of medical images, given the high variability between every patient. Also, the sensitivity of mammographic screening varies with image quality and expertise of the radiologist. So, there is no golden standard for the screening process. To offset this variability and to standardize the diagnostic procedures, efforts are being made to develop automated techniques for diagnosis and grading of breast cancer images. This article presents a classification pipeline to improve the accuracy of differentiation between normal, benign, and malignant mammograms. Several features based on higher-order spectra, local binary pattern, Laws' texture energy, and discrete wavelet transform were extracted from mammograms. Feature selection techniques based on sequential forward, backward, plus-l-takeaway-r, individual, and branch-and-bound selections using the Mahalanobis distance criterion were used to rank the features and find classification accuracies for combination of several features based on the ranking. Six classifiers were used, namely, decision tree classifier, fisher classifier, linear discriminant classifier, nearest mean classifier, Parzen classifier, and support vector machine classifier. We evaluated our proposed methodology with 300 mammograms obtained from the Digital Database for Screening Mammography and 300 mammograms from the Singapore Anti-Tuberculosis Association CommHealth database. Sensitivity, specificity, and accuracy values were used to compare the performances of the classifiers. Our results show that the decision tree classifier demonstrated an excellent performance compared to other classifiers with classification accuracy, sensitivity, and specificity of 91% for the Digital Database for Screening Mammography database and 96.8% for the Singapore Anti-Tuberculosis Association CommHealth database. AD - Department of ECE, Ngee Ann Polytechnic, Singapore, Singapore. U2 - PMID: 23636749. DO - 10.1177/0954411913480669 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109858347&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104076061 T1 - A unified inference procedure for a class of measures to assess improvement in risk prediction systems with survival data. AU - Uno, Hajime AU - Tian, Lu AU - Cai, Tianxi AU - Kohane, Isaac S AU - Wei, L J Y1 - 2013/06/30/ N1 - Accession Number: 104076061. Language: English. Entry Date: 20140124. Revision Date: 20161119. Publication Type: journal article; research. Journal Subset: Biomedical; USA. Special Interest: Evidence-Based Practice. Grant Information: RC4 CA155940/CA/NCI NIH HHS/United States. NLM UID: 8215016. KW - Relative Risk KW - Survival Analysis KW - Statistics KW - Breast Neoplasms KW - Breast Neoplasms -- Mortality KW - Computer Simulation KW - Medical Practice, Evidence-Based -- Statistics and Numerical Data KW - Female KW - Human KW - Cox Proportional Hazards Model KW - ROC Curve KW - Tumor Markers, Biological SP - 2430 EP - 2442 JO - Statistics in Medicine JF - Statistics in Medicine JA - STAT MED VL - 32 IS - 14 CY - Hoboken, New Jersey PB - John Wiley & Sons, Inc. AB - Risk prediction procedures can be quite useful for the patient's treatment selection, prevention strategy, or disease management in evidence-based medicine. Often, potentially important new predictors are available in addition to the conventional markers. The question is how to quantify the improvement from the new markers for prediction of the patient's risk in order to aid cost-benefit decisions. The standard method, using the area under the receiver operating characteristic curve, to measure the added value may not be sensitive enough to capture incremental improvements from the new markers. Recently, some novel alternatives to area under the receiver operating characteristic curve, such as integrated discrimination improvement and net reclassification improvement, were proposed. In this paper, we consider a class of measures for evaluating the incremental values of new markers, which includes the preceding two as special cases. We present a unified procedure for making inferences about measures in the class with censored event time data. The large sample properties of our procedures are theoretically justified. We illustrate the new proposal with data from a cancer study to evaluate a new gene score for prediction of the patient's survival. SN - 0277-6715 AD - Department of Biostatistics and Computational Biology, Dana Farber Cancer Institute, Boston, MA, U.S.A.; Department of Biostatistics, Harvard University, Boston, MA, U.S.A. U2 - PMID: 23037800. DO - 10.1002/sim.5647 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104076061&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104076062 T1 - Comparing diagnostic tests: trials in people with discordant test results. AU - Hooper, R AU - Díaz-Ordaz, K AU - Takeda, A AU - Khan, K Y1 - 2013/06/30/ N1 - Accession Number: 104076062. Language: English. Entry Date: 20140124. Revision Date: 20150710. Publication Type: Journal Article; research. Journal Subset: Biomedical; USA. NLM UID: 8215016. KW - Diagnostic Tests, Routine -- Statistics and Numerical Data KW - Clinical Trials KW - Statistics KW - Breast Neoplasms -- Drug Therapy KW - Breast Neoplasms KW - Chemotherapy, Adjuvant KW - Computer Simulation KW - Confidence Intervals KW - Decision Support Techniques KW - Female KW - Human KW - Models, Statistical KW - Random Assignment KW - Relative Risk KW - Sample Size KW - Gene Expression Profiling SP - 2443 EP - 2456 JO - Statistics in Medicine JF - Statistics in Medicine JA - STAT MED VL - 32 IS - 14 CY - Hoboken, New Jersey PB - John Wiley & Sons, Inc. SN - 0277-6715 AD - Centre for Primary Care and Public Health, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London E1 2AB, U.K. U2 - PMID: 23172716. DO - 10.1002/sim.5676 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104076062&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104178351 T1 - A decision impact, decision conflict and economic assessment of routine Oncotype DX testing of 146 women with node-negative or pNImi, ER-positive breast cancer in the U.K. AU - Holt, S AU - Bertelli, G AU - Humphreys, I AU - Valentine, W AU - Durrani, S AU - Pudney, D AU - Rolles, M AU - Moe, M AU - Khawaja, S AU - Sharaiha, Y AU - Brinkworth, E AU - Whelan, S AU - Jones, S AU - Bennett, H AU - Phillips, C J Y1 - 2013/06/11/ N1 - Accession Number: 104178351. Language: English. Entry Date: 20130927. Revision Date: 20170411. Publication Type: journal article; research. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care. NLM UID: 0370635. KW - Breast Neoplasms -- Drug Therapy KW - Breast Neoplasms KW - Decision Making KW - Adult KW - Aged KW - Breast Neoplasms -- Economics KW - Breast Neoplasms -- Metabolism KW - Cost Benefit Analysis KW - Decision Support Techniques KW - Female KW - Gene Expression Profiling -- Economics KW - Gene Expression Profiling -- Methods KW - Great Britain KW - Human KW - Neoplasm Metastasis KW - Probability KW - Middle Age KW - Models, Statistical KW - Proteins SP - 2250 EP - 2258 JO - British Journal of Cancer JF - British Journal of Cancer JA - BR J CANCER VL - 108 IS - 11 CY - London, PB - Nature Publishing Group AB - Background: Tumour gene expression analysis is useful in predicting adjuvant chemotherapy benefit in early breast cancer patients. This study aims to examine the implications of routine Oncotype DX testing in the U.K. Methods: Women with oestrogen receptor positive (ER+), pNO or pN1mi breast cancer were assessed for adjuvant chemotherapy and subsequently offered Oncotype DX testing, with changes in chemotherapy decisions recorded. A subset of patients completed questionnaires about their uncertainties regarding chemotherapy decisions pre- and post-testing. All patients were asked to complete a diary of medical interactions over the next 6 months, from which economic data were extracted to model the cost-effectiveness of testing. Results: Oncotype DX testing resulted in changes in chemotherapy decisions in 38 of 142 (26.8%) women, with 26 of 57 (45.6%) spared chemotherapy and 12 of 85 (14.1%) requiring chemotherapy when not initially recommended (9.9% reduction overall). Decision conflict analysis showed that Oncotype DX testing increased patients' confidence in treatment decision making. Economic analysis showed that routine Oncotype DX testing costs £6232 per quality-adjusted life year gained. Conclusion: Oncotype DX decreased chemotherapy use and increased confidence in treatment decision making in patients with ER+ early-stage breast cancer. Based on these findings, Oncotype DX is cost-effective in the UK setting. SN - 0007-0920 AD - Department of Breast Surgery, Prince Philip Hospital, Llanelli, Wales SA14 8QF, UK. U2 - PMID: 23695023. DO - 10.1038/bjc.2013.207 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104178351&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104171172 T1 - Characterization of spatiotemporal changes for the classification of dynamic contrast-enhanced magnetic-resonance breast lesions. AU - Milenkovic, Jana AU - Hertl, Kristijana AU - Kosir, Andrej AU - Zibert, Janez AU - Tasic, Jurij Franc Y1 - 2013/06// N1 - Accession Number: 104171172. Language: English. Entry Date: 20131101. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Blind Peer Reviewed; Computer/Information Science; Continental Europe; Europe; Expert Peer Reviewed; Peer Reviewed. Special Interest: Informatics. NLM UID: 8915031. KW - Artificial Intelligence KW - Breast Neoplasms -- Diagnosis KW - Contrast Media -- Diagnostic Use KW - Diagnosis, Computer Assisted -- Methods KW - Image Interpretation, Computer Assisted KW - Magnetic Resonance Imaging KW - Pharmacokinetics KW - Breast Neoplasms -- Classification KW - Breast Neoplasms -- Pathology KW - Decision Support Techniques KW - Early Detection of Cancer KW - Female KW - Human KW - Regression KW - Logistic Regression KW - Predictive Value of Tests KW - ROC Curve KW - Time Factors SP - 101 EP - 114 JO - Artificial Intelligence in Medicine JF - Artificial Intelligence in Medicine JA - ARTIF INTELL MED VL - 58 IS - 2 PB - Elsevier B.V. SN - 0933-3657 AD - Jozef Stefan Institute, Jamova 39, 1000 Ljubljana, Slovenia. Electronic address: jana.milenkovic@ijs.si. U2 - PMID: 23548472. DO - 10.1016/j.artmed.2013.03.002 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104171172&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107824302 T1 - An introduction to patient decision aids. Y1 - 2013/06// N1 - Accession Number: 107824302. Corporate Author: Drug and Therapeutics Bulletin. Language: English. Entry Date: 20140919. Revision Date: 20150712. Publication Type: Journal Article; research. Journal Subset: Biomedical; Europe; UK & Ireland. Special Interest: Evidence-Based Practice. NLM UID: 8900488. KW - Decision Making KW - Decision Support Techniques KW - Consumer Participation KW - Physician-Patient Relations KW - Antibiotics -- Adverse Effects KW - Antibiotics -- Therapeutic Use KW - Breast Neoplasms -- Surgery KW - Child KW - Decision Making, Computer Assisted KW - Diarrhea -- Chemically Induced KW - Medical Practice, Evidence-Based KW - Exanthema -- Chemically Induced KW - Female KW - Great Britain KW - Human KW - Mastectomy KW - Lumpectomy KW - Otitis Media -- Drug Therapy KW - Patient Education KW - Referral and Consultation KW - Relative Risk KW - National Health Programs KW - Vomiting -- Chemically Induced SP - f4147 EP - f4147 JO - BMJ: British Medical Journal (Clinical Research Edition) JF - BMJ: British Medical Journal (Clinical Research Edition) JA - BMJ BR MED J (CLIN RES ED) VL - 347 PB - BMJ Publishing Group SN - 0959-8138 U2 - PMID: 23881944. DO - 10.1136/bmj.f4147 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107824302&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104198110 T1 - 13th St. Gallen International Breast Cancer Conference 2013: Primary Therapy of Early Breast Cancer Evidence, Controversies, Consensus - Opinion of a German Team of Experts (Zurich 2013) AU - Untch*, Michael AU - Gerber, Bernd AU - Harbeck, Nadia AU - Jackisch, Christian AU - Marschner, Norbert AU - Möbus, Volker AU - von Minckwitz, Gunter AU - Loibl*, Sibylle AU - Beckmann, Matthias W. AU - Blohmer, Jens-Uwe AU - Costa, Serban-Dan AU - Decker, Thomas AU - Diel, Ingo AU - Dimpfl, Thomas AU - Eiermann, Wolfgang AU - Fehm, Tanja AU - Friese, Klaus AU - Jänicke, Fritz AU - Janni, Wolfgang AU - Jonat, Walter Y1 - 2013/06// N1 - Accession Number: 104198110. Language: English. Entry Date: 20130730. Revision Date: 20150711. Publication Type: Journal Article; standards. Journal Subset: Biomedical; Blind Peer Reviewed; Continental Europe; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed. Special Interest: Oncologic Care. NLM UID: 101254060. KW - Breast Neoplasms -- Therapy KW - Oncologic Care -- Standards KW - Practice Guidelines KW - Congresses and Conferences -- Germany KW - Germany KW - Women's Health SP - 221 EP - 229 JO - Breast Care JF - Breast Care JA - BREAST CARE VL - 8 IS - 3 PB - Karger AG AB - The International Consensus Conference on the treatment of primary breast cancer takes place every two years in St. Gallen, Switzerland. The panel in St. Gallen is composed of international experts from different countries. From a German perspective, it seems reasonable to interpret the voting results in the light of AGO-recommendations and S3-guidelines for everyday practice in Germany. Consequently, a team of eight breast cancer experts, of whom two are members of the international St. Gallen panel, commented on the voting results of the St. Gallen Consensus Conference (2013). The main topics at this year's St. Gallen conference were surgical issues of the breast and axilla, radio-therapeutic and systemic treatment options, and the clinical relevance of tumour biology. The clinical utility of multigene assays for supporting individual treatment decisions was also intensively discussed. Copyright © 2013 S. Karger AG, Basel SN - 1661-3791 U2 - PMID: 24415975. DO - 10.1159/000351692 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104198110&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104171649 T1 - A peer-led decision support intervention improves decision outcomes in black women with breast cancer. AU - Sheppard, Vanessa B AU - Wallington, Sherrie F AU - Willey, Shawna C AU - Hampton, Regina M AU - Lucas, W AU - Jennings, Y AU - Horton, S AU - Muzeck, N AU - Cocilovo, C AU - Isaacs, C Y1 - 2013/06// N1 - Accession Number: 104171649. Language: English. Entry Date: 20131025. Revision Date: 20161119. Publication Type: journal article; research. Journal Subset: Biomedical; Blind Peer Reviewed; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Health Promotion/Education; Peer Reviewed; USA. Special Interest: Oncologic Care. Grant Information: R01 CA127617/CA/NCI NIH HHS/United States. NLM UID: 8610343. KW - Blacks -- Psychosocial Factors KW - Breast Neoplasms -- Ethnology KW - Breast Neoplasms -- Therapy KW - Decision Making KW - Patient Centered Care KW - Peer Group KW - Support, Psychosocial KW - Adult KW - Aged KW - Aged, 80 and Over KW - Breast Neoplasms -- Psychosocial Factors KW - District of Columbia KW - Female KW - Prospective Studies KW - Human KW - Middle Age KW - Patient Attitudes -- Ethnology KW - Patient Attitudes KW - Physician-Patient Relations KW - Power KW - Self-Efficacy SP - 262 EP - 269 JO - Journal of Cancer Education JF - Journal of Cancer Education JA - J CANCER EDUC VL - 28 IS - 2 CY - , PB - Springer Science & Business Media B.V. AB - Previous reports suggest that Black breast cancer patients receive less patient-centered cancer care than their White counterparts. Interventions to improve patient-centered care (PCC) in Black breast cancer patients are lacking. Seventy-six women with histologically confirmed breast cancer were recruited from the Washington, DC area. After a baseline telephone interview, women received an in-person decision support educational session led by a trained survivor coach. The coach used a culturally appropriate guidebook and decision-making model-TALK Back!(©) A follow-up assessment assessed participants' acceptability of the intervention and intermediate outcomes. After the intervention, participants reported increased: self-efficacy in communicating with providers (70 %) and self-efficacy in making treatment decisions (70 %). Compared to baseline scores, post-intervention communication with providers significantly increased (p= .000). This is the first outcome report of an intervention to facilitate PCC in Black breast cancer patients. Testing this intervention using RCTs or similar designs will be important next steps. SN - 0885-8195 AD - Georgetown University Medical Center, Washington, DC, 20007, USA, vls3@georgetown.edu. U2 - PMID: 23576067. DO - 10.1007/s13187-013-0459-z UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104171649&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 87446035 T1 - Talking to Children About Maternal BRCA1/2 Genetic Test Results: A Qualitative Study of Parental Perceptions and Advice. AU - Patenaude, Andrea AU - DeMarco, Tiffani AU - Peshkin, Beth AU - Valdimarsdottir, Heiddis AU - Garber, Judy AU - Schneider, Katherine AU - Hewitt, Larissa AU - Hamilton, Jennifer AU - Tercyak, Kenneth Y1 - 2013/06// N1 - Accession Number: 87446035. Language: English. Entry Date: 20130514. Revision Date: 20160615. Publication Type: Article; research; tables/charts. Journal Subset: Biomedical; Continental Europe; Europe; Peer Reviewed. Grant Information: This work was funded by grant # R01HG002686 from the Ethical, Legal, and Social Implications Research Program of the National Human Genome Research Institute, National Institutes of Health.. NLM UID: 9206865. KW - Parental Attitudes KW - Parent-Child Relations KW - Self Disclosure KW - Breast Neoplasms -- Familial and Genetic KW - Ovarian Neoplasms -- Familial and Genetic KW - Human KW - Genes, BRCA KW - Interviews KW - Female KW - Qualitative Studies KW - Male KW - Audiorecording KW - Descriptive Statistics KW - Adult KW - Middle Age KW - Genetic Screening KW - Funding Source SP - 303 EP - 314 JO - Journal of Genetic Counseling JF - Journal of Genetic Counseling JA - J GENETIC COUNS VL - 22 IS - 3 CY - , PB - Springer Science & Business Media B.V. AB - Family communication is the primary, initial means of educating the next, at-risk generation about hereditary cancer risk. In this study, in-depth parent narratives provided self-report of motivations, planning, satisfactions and regrets associated with sharing or not sharing maternal BRCA1/2 test results with young children and advice for parents considering disclosure and for genetic counselors. Interviews were conducted with 32 mothers tested for BRCA1/2 with children ages 8-21 years and 24 of their co-parents; interview narratives were analyzed qualitatively. Parents were concerned with both protecting and educating children about hereditary cancer risk. They expressed confidence that parents can constructively convey genetic information to minor children. Telling relieved most parents and satisfied a sense of parental duty. Parents strongly advised child-specific, age-appropriate tailoring of genetic information and emphasized conveying the positive, preventive utility of genetic information to children. Immunizing effects of disclosure were viewed as providing forewarning about and preparation for possible later family cancer diagnoses. Parents choosing not to tell children were advised to consider future disclosure. Narratives about parental sharing of BRCA1/2 test results with minor children support the feasibility of parental discussion of maternal genetic test results to the next at-risk generation. Results suggest development of intervention tools for parents would support decision-making and family communication and potentially reduce parental worry and regret. Recommendations are made for more active involvement by genetic counselors with tested parents around the topic of delivery of genetic information to children. SN - 1059-7700 AD - Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue Boston 02215 USA AD - Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street N.W., Suite 4100 Washington 20007-2401 USA AD - Milton Academy, 170 Centre Street Milton 02186 USA DO - 10.1007/s10897-012-9549-z UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=87446035&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - GEN ID - 87446033 T1 - Erratum to: Development and Evaluation of a Decision Aid for BRCA Carriers with Breast Cancer...Culver, J.O., MacDonald, D.J., Thornton A.A., et al. J Genet Couns. 2011 Jun; 20(3):294–307. AU - Culver, Julie AU - MacDonald, Deborah AU - Thornton, Andrea AU - Sand, Sharon AU - Grant, Marcia AU - Bowen, Deborah AU - Burke, Harry AU - Garcia, Nellie AU - Metcalfe, Kelly AU - Weitzel, Jeffrey Y1 - 2013/06// N1 - Accession Number: 87446033. Language: English. Entry Date: 20130514. Revision Date: 20140602. Publication Type: Correction notice; corrected article. Journal Subset: Biomedical; Continental Europe; Europe; Peer Reviewed. NLM UID: 9206865. SP - 406 EP - 406 JO - Journal of Genetic Counseling JF - Journal of Genetic Counseling JA - J GENETIC COUNS VL - 22 IS - 3 CY - , PB - Springer Science & Business Media B.V. AB - A correction is presented for the article "Development and Evaluation of a Decision Aid for BRCA Carriers With Breast Cancer" by Julie O. Culver et al. SN - 1059-7700 AD - Division of Clinical Cancer Genetics, Department of Population Sciences, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road Mod 173 Duarte 91010-3000 USA AD - Division of Behavioral Oncology, Department of Population Sciences, & Division of Psychology, Department of Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte USA AD - Division of Nursing Research and Education, Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte USA AD - Department of Social and Behavioral Sciences, Boston University, Boston USA AD - Department of Medicine, Biochemistry and Molecular Biology, George Washington University School of Medicine, Washington USA AD - Department of Clinical Social Work, Sheri & Les Biller Patient and Family Resource Center, City of Hope Comprehensive Cancer Center, Duarte USA AD - Women's College Research Institute, University of Toronto, Toronto Canada DO - 10.1007/s10897-012-9513-y UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=87446033&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 103807777 T1 - Results from a randomized trial of a web-based, tailored decision aid for women at high risk for breast cancer. AU - Banegas, Matthew P AU - McClure, Jennifer B AU - Barlow, William E AU - Ubel, Peter A AU - Smith, Dylan M AU - Zikmund-Fisher, Brian J AU - Greene, Sarah M AU - Fagerlin, Angela Y1 - 2013/06// N1 - Accession Number: 103807777. Language: English. Entry Date: 20150116. Revision Date: 20161222. Publication Type: journal article; research; randomized controlled trial. Journal Subset: Core Nursing; Europe; Health Promotion/Education; Nursing; Peer Reviewed; UK & Ireland. Grant Information: U54 CA153502/CA/NCI NIH HHS/United States. NLM UID: 8406280. KW - Breast Neoplasms -- Psychosocial Factors KW - Decision Support Techniques KW - Raloxifene -- Therapeutic Use KW - Tamoxifen -- Therapeutic Use KW - Aged KW - Breast Neoplasms -- Drug Therapy KW - Breast Neoplasms -- Prevention and Control KW - Conflict (Psychology) KW - Female KW - Human KW - Internet KW - Michigan KW - Middle Age KW - Risk Factors KW - Treatment Outcomes SP - 364 EP - 371 JO - Patient Education & Counseling JF - Patient Education & Counseling JA - PATIENT EDUC COUNS VL - 91 IS - 3 PB - Elsevier B.V. AB - Objective: To assess the impact of Guide to Decide (GtD), a web-based, personally-tailored decision aid designed to inform women's decisions about prophylactic tamoxifen and raloxifene use.Methods: Postmenopausal women, age 46-74, with BCRAT 5-year risk ≥ 1.66% and no prior history of breast cancer were randomized to one of three study arms:intervention (n=690), Time 1 control (n=160), or 3-month control (n=162). Intervention participants viewed GtD prior to completing a post-test and 3 month follow-up assessment. Controls did not. We assessed the impact of GtD on women's decisional conflict levels and treatment decision behavior at post-test and at 3 months, respectively.Results: Intervention participants had significantly lower decisional conflict levels at post-test (p<0.001) and significantly higher odds of making a decision about whether or not to take prophylactic tamoxifen or raloxifene at 3-month follow-up (p<0.001) compared to control participants.Conclusion: GtD lowered decisional conflict and helped women at high risk of breast cancer decide whether to take prophylactic tamoxifen or raloxifene to reduce their cancer risk.Practice Implications: Web-based, tailored decision aids should be used more routinely to facilitate informed medical decisions, reduce patients' decisional conflict, and empower patients to choose the treatment strategy that best reflects their own values. SN - 0738-3991 AD - University of Washington, Department of Health Services, Seattle, USA; Fred Hutchinson Cancer Research Center, Seattle, USA. Electronic address: banegasmp@mail.nih.gov. U2 - PMID: 23395006. DO - 10.1016/j.pec.2012.12.014 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103807777&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104280624 T1 - What is lacking in current decision aids on cancer screening? AU - Jimbo, Masahito AU - Rana, Gurpreet K AU - Hawley, Sarah AU - Holmes-Rovner, Margaret AU - Kelly-Blake, Karen AU - Nease Jr, Donald E AU - Ruffin 4th, Mack T AU - Nease, Donald E Jr AU - Ruffin, Mack T 4th Y1 - 2013/05//May/Jun2013 N1 - Accession Number: 104280624. Language: English. Entry Date: 20130719. Revision Date: 20161117. Publication Type: journal article; review. Journal Subset: Biomedical; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Oncologic Care. Grant Information: R01 CA152413/CA/NCI NIH HHS/United States. NLM UID: 0370647. KW - Breast Neoplasms -- Diagnosis KW - Colorectal Neoplasms -- Diagnosis KW - Decision Support Techniques KW - Early Detection of Cancer -- Methods KW - Early Detection of Cancer -- Psychosocial Factors KW - Early Detection of Cancer -- Standards KW - Consumer Participation KW - Prostatic Neoplasms -- Diagnosis KW - Cervix Neoplasms -- Diagnosis KW - Female KW - Male KW - Outcomes (Health Care) KW - Practice Guidelines KW - Risk Assessment SP - 193 EP - 214 JO - CA: A Cancer Journal for Clinicians JF - CA: A Cancer Journal for Clinicians JA - CA VL - 63 IS - 3 CY - Malden, Massachusetts PB - Wiley-Blackwell AB - Recent guidelines on cancer screening have provided not only more screening options but also conflicting recommendations. Thus, patients, with their clinicians' support, must decide whether to get screened, which modality to use, and how often to undergo screening. Decision aids could potentially lead to better shared decision-making regarding screening between the patient and the clinician. A total of 73 decision aids concerning screening for breast, cervical, colorectal, and prostate cancers were reviewed. The goal of this review was to assess the effectiveness of such decision aids, examine areas in need of more research, and determine how the decision aids can be currently applied in the real-world setting. Most studies used sound study designs. Significant variation existed in the setting, theoretical framework, and measured outcomes. Just over one-third of the decision aids included an explicit values clarification. Other than knowledge, little consistency was noted with regard to which patient attributes were measured as outcomes. Few studies actually measured shared decision-making. Little information was available regarding the feasibility and outcomes of integrating decision aids into practice. In this review, the implications for future research, as well as what clinicians can do now to incorporate decision aids into their practice, are discussed. SN - 0007-9235 AD - Associate Professor, Departments of Family Medicine and Urology, University of Michigan, Ann Arbor, MI. mjimbo@med.umich.edu. U2 - PMID: 23504675. DO - 10.3322/caac.21180 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104280624&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104071241 T1 - Breast cancer treatment decision-making: are we asking too much of patients? AU - Livaudais, Jennifer C AU - Franco, Rebeca AU - Fei, Kezhen AU - Bickell, Nina A Y1 - 2013/05// N1 - Accession Number: 104071241. Language: English. Entry Date: 20140523. Revision Date: 20161119. Publication Type: journal article; research; randomized controlled trial. Commentary: George Susan. Capsule commentary on livaudais, et Al., breast cancer treatment decision-making: are we asking too much of patients? (J GEN INTERN MED) May2013; 28 (5): 706-706. Journal Subset: Biomedical; Continental Europe; Europe. Grant Information: R01 CA107051/CA/NCI NIH HHS/United States. NLM UID: 8605834. KW - Breast Neoplasms -- Therapy KW - Decision Making KW - Attitude to Health KW - Physician-Patient Relations KW - Adult KW - Aged KW - Aged, 80 and Over KW - Breast Neoplasms -- Psychosocial Factors KW - Chemotherapy, Adjuvant KW - Female KW - Human KW - Prospective Studies KW - Middle Age KW - New York KW - Consumer Participation -- Psychosocial Factors KW - Self-Efficacy KW - Socioeconomic Factors SP - 630 EP - 636 JO - JGIM: Journal of General Internal Medicine JF - JGIM: Journal of General Internal Medicine JA - J GEN INTERN MED VL - 28 IS - 5 CY - , PB - Springer Science & Business Media B.V. AB - Objective: Physicians are mandated to offer treatment choices to patients, yet not all patients may want the responsibility that entails. We evaluated predisposing factors for, and long-term consequences of, too much and not enough perceived decision-making responsibility among breast cancer patients.Design: Longitudinal assessment, with measurements collected just after surgical treatment (baseline) and 6-month follow-up.Participants: Women with early-stage breast cancer treated surgically at eight NYC hospitals, recruited for a randomized controlled trial of patient assistance to improve receipt of adjuvant treatment.Measurements: Using logistic regression, we explored multivariable-adjusted associations between perceived treatment decision-making responsibility and a) baseline knowledge of treatment benefit and b) 6-month decision regret.Results: Of 368 women aged 28-89 years, 72 % reported a "reasonable amount", 21 % "too much", and 7 % "not enough" responsibility for treatment decision-making at baseline. Health literacy problems were most common among those with "not enough" (68 %) and "too much" responsibility (62 %). Only 29 % of women had knowledge of treatment benefits; 40 % experienced 6-month decision regret. In multivariable analysis, women reporting "too much" vs. "reasonable amount" of responsibility had less treatment knowledge ([OR] = 0.44, [95 % CI] = 0.20-0.99; model c = 0.7343;p < 0.01) and more decision regret ([OR] = 2.,91 [95 % CI] = 1.40-6.06; model c = 0.7937;p < 0.001). Findings were similar for women reporting "not enough" responsibility, though not statistically significant.Conclusion: Too much perceived responsibility for breast cancer treatment decisions was associated with poor baseline treatment knowledge and 6-month decision regret. Health literacy problems were common, suggesting that health care professionals find alternative ways to communicate with low health literacy patients, enabling them to assume the desired amount of decision-making responsibility, thereby reducing decision regret. SN - 0884-8734 AD - Department of Health Evidence and Policy, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA, jclivaudais@gmail.com. U2 - PMID: 23229908. DO - 10.1007/s11606-012-2274-3 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104071241&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 109856286 T1 - Prediction of the Oncotype DX recurrence score: use of pathology-generated equations derived by linear regression analysis. AU - Klein, Molly E AU - Dabbs, David J AU - Shuai, Yongli AU - Brufsky, Adam M AU - Jankowitz, Rachel AU - Puhalla, Shannon L AU - Bhargava, Rohit Y1 - 2013/05// N1 - Accession Number: 109856286. Language: English. Entry Date: 20150724. Revision Date: 20161117. Publication Type: journal article; research. Journal Subset: Biomedical; USA. Special Interest: Laboratory Diagnosis. Grant Information: P30 CA047904/CA/NCI NIH HHS/United States. NLM UID: 8806605. KW - Algorithms KW - Breast Neoplasms -- Drug Therapy KW - Breast Neoplasms KW - Decision Support Techniques KW - Neoplasm Recurrence, Local KW - Female KW - Gene Expression Profiling KW - Human KW - Linear Regression KW - Tumor Markers, Biological -- Analysis KW - Tumor Markers, Biological SP - 658 EP - 664 JO - Modern Pathology JF - Modern Pathology JA - MOD PATHOL VL - 26 IS - 5 CY - London, PB - Nature Publishing Group AB - Oncotype DX is a commercial assay frequently used for making chemotherapy decisions in estrogen receptor (ER)-positive breast cancers. The result is reported as a recurrence score ranging from 0 to 100, divided into low-risk (<18), intermediate-risk (18-30), and high-risk (≥31) categories. Our pilot study showed that recurrence score can be predicted by an equation incorporating standard morphoimmunohistologic variables (referred to as original Magee equation). Using a data set of 817 cases, we formulated three additional equations (referred to as new Magee equations 1, 2, and 3) to predict the recurrence score category for an independent set of 255 cases. The concordance between the risk category of Oncotype DX and our equations was 54.3%, 55.8%, 59.4%, and 54.4% for original Magee equation, new Magee equations 1, 2, and 3, respectively. When the intermediate category was eliminated, the concordance increased to 96.9%, 100%, 98.6%, and 98.7% for original Magee equation, new Magee equations 1, 2, and 3, respectively. Even when the estimated recurrence score fell in the intermediate category with any of the equations, the actual recurrence score was either intermediate or low in more than 80% of the cases. Any of the four equations can be used to estimate the recurrence score depending on available data. If the estimated recurrence score is clearly high or low, the oncologists should not expect a dramatically different result from Oncotype DX, and the Oncotype DX test may not be needed. Conversely, an Oncotype DX result that is dramatically different from what is expected based on standard morphoimmunohistologic variables should be thoroughly investigated. SN - 0893-3952 AD - Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA. U2 - PMID: 23503643. DO - 10.1038/modpathol.2013.36 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109856286&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104243123 T1 - A fuzzy rule-based approach for characterization of mammogram masses into BI-RADS shape categories. AU - Vadivel, A AU - Surendiran, B Y1 - 2013/04// N1 - Accession Number: 104243123. Language: English. Entry Date: 20131011. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Computer/Information Science; USA. NLM UID: 1250250. KW - Breast -- Pathology KW - Breast Neoplasms -- Diagnosis KW - Breast Neoplasms -- Pathology KW - Mammography -- Methods KW - Algorithms KW - Decision Trees KW - Early Detection of Cancer -- Methods KW - Female KW - Logic KW - Human KW - Image Processing, Computer Assisted -- Methods KW - Models, Theoretical KW - Information Science KW - Reproducibility of Results SP - 259 EP - 267 JO - Computers in Biology & Medicine JF - Computers in Biology & Medicine JA - COMPUT BIOL MED VL - 43 IS - 4 CY - Philadelphia, Pennsylvania PB - Elsevier B.V. SN - 0010-4825 AD - Multimedia Information Retrieval Group, National Institute of Technology, Tiruchirappalli, India. Electronic address: vadi@nitt.edu. U2 - PMID: 23414779. DO - 10.1016/j.compbiomed.2013.01.004 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104243123&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104242876 T1 - The relationship between communication and health-related quality of life in survivorship care for Chinese-American and Korean-American breast cancer survivors. AU - Lim, Jung-Won AU - Paek, Min-So Y1 - 2013/04// N1 - Accession Number: 104242876. Language: English. Entry Date: 20130927. Revision Date: 20161117. Publication Type: journal article; research. Journal Subset: Biomedical; Continental Europe; Double Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed. Special Interest: Oncologic Care. Grant Information: R03 CA139941/CA/NCI NIH HHS/United States. NLM UID: 9302957. KW - Asians KW - Breast Neoplasms -- Ethnology KW - Breast Neoplasms -- Mortality KW - Breast Neoplasms -- Psychosocial Factors KW - Communication KW - Health Status KW - Quality of Life KW - Aged KW - California KW - China -- Ethnology KW - Cross Sectional Studies KW - Female KW - Human KW - Middle Age KW - Physician-Patient Relations KW - Questionnaires KW - South Korea -- Ethnology KW - Survival SP - 1157 EP - 1166 JO - Supportive Care in Cancer JF - Supportive Care in Cancer JA - SUPPORT CARE CANCER VL - 21 IS - 4 CY - , PB - Springer Science & Business Media B.V. AB - Objective: The purpose of this study was (1) to compare family communication, decision support (i.e., supporting the patient in making decisions), self-efficacy in patient-physician communication (i.e., patients' confidence level in communicating with physicians), and health-related quality of life (HRQOL) between Chinese-American and Korean-American breast cancer survivors (BCS) and (2) to investigate how family communication, decision support, and self-efficacy in patient-physician communication influence HRQOL for Chinese-American and Korean-American BCS.Methods: A cross-sectional design was used. A total of 157 Chinese-American (n = 86) and Korean-American (n = 71) BCS were recruited from the California Cancer Surveillance Program and area hospitals in Los Angeles County. The chronic care model was utilized.Results: Chinese-Americans and Korean-Americans showed a significant difference in the decision support only. Self-efficacy in patient-physician communication was directly associated with HRQOL for Chinese-Americans, whereas for Korean-Americans, family communication was related to HRQOL. The mediating effects of decision support and self-efficacy in physician-patient communication in the relationship between family communication and HRQOL were observed for Chinese-Americans only. Multiple group analysis demonstrated that the structural paths varied between Chinese-American and Korean-American BCS.Conclusions: Our results provide insight into the survivorship care of Chinese-American and Korean-American BCS, allowing a better understanding of communication among survivors, family, and healthcare providers. Communication skills to manage conflict and attain consensus among them under the cultural contexts are essential to improve HRQOL for BCS. SN - 0941-4355 AD - Mandel School of Applied Social Sciences, Case Western Reserve University, 10900 Euclid Avenue, 44106, Cleveland, OH, USA, jung-won.lim@case.edu. U2 - PMID: 23111944. DO - 10.1007/s00520-012-1641-2 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104242876&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104249061 T1 - Factors Associated with Surgical Decision Making in Women with Early-Stage Breast Cancer: A Literature Review. AU - Bride, Maire Brid Mac AU - Neal, Lonzetta AU - Dilaveri, Christina A. AU - Sandhu, Nicole P. AU - Hieken, Tina J. AU - Ghosh, Karthik AU - Wahner-Roedler, Dietlind L. Y1 - 2013/03// N1 - Accession Number: 104249061. Language: English. Entry Date: 20130318. Revision Date: 20150820. Publication Type: Journal Article; research; systematic review. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Evidence-Based Practice; Oncologic Care; Women's Health. NLM UID: 101159262. KW - Breast Neoplasms KW - Decision Making, Patient KW - Neoplasm Staging KW - Mastectomy -- Classification KW - Human KW - Minnesota KW - Systematic Review KW - Medline KW - Embase KW - Psycinfo KW - CINAHL Database KW - Race Factors KW - Whites KW - Blacks KW - Hispanics KW - Socioeconomic Factors KW - Geographic Factors SP - 236 EP - 242 JO - Journal of Women's Health (15409996) JF - Journal of Women's Health (15409996) JA - J WOMENS HEALTH (15409996) VL - 22 IS - 3 CY - New Rochelle, New York PB - Mary Ann Liebert, Inc. AB - Background: Current recommendations for surgical management of early-stage breast cancer include breast-conserving surgery with postoperative irradiation. However, studies show that mastectomy is still being used by women with early-stage breast cancer. Methods: Review of the medical literature published between 2000 and 2010 to determine the factors associated with the decision of patients for surgical treatment in early-stage breast cancer. Results: The following patient characteristics affect the surgical decision-making process in early-stage breast cancer: age, socioeconomic factors, geographic area in which the patient lives, proximity to a radiation therapy center, testing for BRCA gene, breast imaging, and decision aids. Conclusions: Of increasing importance in the decision making about treatment of women with early-stage breast cancer are the woman's perception of having a surgical choice and the influence of that choice on postoperative quality of life. SN - 1540-9996 AD - Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota. AD - Division of Gastroenterologic and General Surgery, Mayo Clinic, Rochester, Minnesota. U2 - PMID: 23428286. DO - 10.1089/jwh.2012.3969 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104249061&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107991090 T1 - Improving Employment Outcomes in Breast Cancer Survivors: Evaluation of a Personalized Decision Support Tool. AU - Sesti, M E Y1 - 2013/03// N1 - Accession Number: 107991090. Language: English. Entry Date: 20130830. Revision Date: 20150712. Publication Type: Journal Article; abstract; research. Journal Subset: Allied Health; Editorial Board Reviewed; Peer Reviewed; USA. Special Interest: Oncologic Care; Physical Therapy; Women's Health. Instrumentation: Work Ability Improvement Through Symptom Mananagement and Ergonomic Strategies (WISE). KW - Breast Neoplasms KW - Cancer Survivors KW - Decision Making, Clinical KW - Employment KW - Instrument Validation KW - Scales KW - Work Capacity Evaluation -- Methods KW - Conceptual Framework KW - Descriptive Statistics KW - Ergonomics KW - Female KW - Human KW - Pilot Studies KW - Questionnaires KW - Rehabilitation, Vocational KW - Semi-Structured Interview KW - Validation Studies KW - Validity KW - Wisconsin KW - Women's Health SP - 49 EP - 50 JO - Rehabilitation Oncology JF - Rehabilitation Oncology JA - REHABIL ONCOL VL - 31 IS - 1 CY - Alexandria, Virginia PB - American Physical Therapy Association, Oncology Section SN - 2168-3808 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107991090&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104312542 T1 - Patient income level and cancer clinical trial participation. AU - Unger JM AU - Hershman DL AU - Albain KS AU - Moinpour CM AU - Petersen JA AU - Burg K AU - Crowley JJ AU - Unger, Joseph M AU - Hershman, Dawn L AU - Albain, Kathy S AU - Moinpour, Carol M AU - Petersen, Judith A AU - Burg, Kenda AU - Crowley, John J Y1 - 2013/02/10/ N1 - Accession Number: 104312542. Language: English. Entry Date: 20130412. Revision Date: 20161117. Publication Type: journal article; research. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Oncologic Care. Grant Information: U10 CA037429/CA/NCI NIH HHS/United States. NLM UID: 8309333. KW - Clinical Trials KW - Consumer Participation -- Psychosocial Factors KW - Consumer Participation -- Statistics and Numerical Data KW - Income KW - Neoplasms -- Therapy KW - Patients KW - Research Subjects -- Economics KW - Research Subjects -- Psychosocial Factors KW - Adult KW - Age Factors KW - Aged KW - Breast Neoplasms -- Therapy KW - Colorectal Neoplasms -- Therapy KW - Decision Support Techniques KW - Educational Status KW - Female KW - Human KW - Logistic Regression KW - Lung Neoplasms -- Therapy KW - Male KW - Medicare KW - Middle Age KW - Odds Ratio KW - Prostatic Neoplasms -- Therapy KW - Questionnaires KW - United States SP - 536 EP - 542 JO - Journal of Clinical Oncology JF - Journal of Clinical Oncology JA - J CLIN ONCOL VL - 31 IS - 5 CY - Alexandria, Virginia PB - American Society of Clinical Oncology AB - Purpose: Studies have shown an association between socioeconomic status (SES) and quality of oncology care, but less is known about the impact of patient SES on clinical trial participation.Patients and Methods: We assessed clinical trial participation patterns according to important SES (income, education) and demographic factors in a large sample of patients surveyed via an Internet-based treatment decision tool. Logistic regression, conditioning on type of cancer, was used. Attitudes toward clinical trials were assessed using prespecified items about treatment, treatment tolerability, convenience, and cost.Results: From 2007 to 2011, 5,499 patients were successfully surveyed. Forty percent discussed clinical trials with their physician, 45% of discussions led to physician offers of clinical trial participation, and 51% of offers led to clinical trial participation. The overall clinical trial participation rate was 9%. In univariate models, older patients (P = .002) and patients with lower income (P = .001) and education (P = .02) were less likely to participate in clinical trials. In a multivariable model, income remained a statistically significant predictor of clinical trial participation (odds ratio, 0.73; 95% CI, 0.57 to 0.94; P = .01). Even in patients age ≥ 65 years, who have universal access to Medicare, lower income predicted lower trial participation. Cost concerns were much more evident among lower-income patients (P < .001).Conclusion: Lower-income patients were less likely to participate in clinical trials, even when considering age group. A better understanding of why income is a barrier may help identify ways to make clinical trials better available to all patients and would increase the generalizability of clinical trial results across all income levels. SN - 0732-183X AD - SWOG Statistical Center, Fred Hutchinson Cancer Research Center, M3-C102, 1100 Fairview Ave, Seattle, WA 98109, USA AD - PhC, SWOG Statistical Center, Fred Hutchinson Cancer Research Center, M3-C102, 1100 Fairview Ave, Seattle, WA 98109; junger@fhcrc.org. U2 - PMID: 23295802. DO - 10.1200/JCO.2012.45.4553 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104312542&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 108022051 T1 - Observer study of a prototype clinical decision support system for breast cancer diagnosis using dynamic contrast-enhanced MRI. AU - Boroczky L AU - Simpson M AU - Abe H AU - Drysdale J Y1 - 2013/02//2013 Feb N1 - Accession Number: 108022051. Language: English. Entry Date: 20130419. Revision Date: 20150712. Publication Type: Journal Article; research. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Diagnostic Imaging. NLM UID: 7708173. KW - Breast Neoplasms -- Diagnosis KW - Decision Support Systems, Clinical KW - Magnetic Resonance Imaging -- Methods KW - Biopsy KW - Breast Neoplasms -- Pathology KW - Contrast Media -- Diagnostic Use KW - Diagnosis, Differential KW - Female KW - Human KW - Middle Age KW - Observer Bias KW - Predictive Value of Tests KW - ROC Curve KW - Retrospective Design KW - Sensitivity and Specificity SP - 277 EP - 283 JO - American Journal of Roentgenology JF - American Journal of Roentgenology JA - AJR AM J ROENTGENOL VL - 200 IS - 2 CY - Leesburg, Virginia PB - American Roentgen Ray Society SN - 0361-803X AD - Philips Research North America, 345 Scarborough Rd, Briarcliff Manor, NY 10510. U2 - PMID: 23345346. DO - 10.2214/AJR.12.8718 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=108022051&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107998729 T1 - Cost-benefit analysis of decision support methods for patients with breast cancer in a rural community. AU - Wilson, Leslie AU - Loucks, Aimee AU - Stupar, Lauren AU - O'Donnell, Sara AU - Moore, Dan AU - Belkora, Jeff Y1 - 2013/02//2013 Feb N1 - Accession Number: 107998729. Language: English. Entry Date: 20130607. Revision Date: 20150712. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Oncologic Care; Women's Health. Grant Information: This study was funded by the California Breast Cancer Research Program (#12BB-3900).. NLM UID: 101223547. KW - Breast Neoplasms -- Therapy KW - Cost Benefit Analysis KW - Decision Making KW - Support, Psychosocial KW - Academic Medical Centers KW - Aged KW - California KW - Descriptive Statistics KW - Female KW - Fisher's Exact Test KW - Funding Source KW - Human KW - Linear Regression KW - Middle Age KW - Rural Health KW - Sensitivity and Specificity KW - Surveys KW - T-Tests KW - Wilcoxon Rank Sum Test SP - 47 EP - 57 JO - Community Oncology JF - Community Oncology JA - COMMUNITY ONCOL VL - 10 IS - 2 PB - Elsevier B.V. SN - 1548-5315 AD - University of California, San Francisco AD - Cancer Resource Centers of Mendocino County, Mendocino, California AD - Department of Statistics, California Pacific Medical Center, San Francisco UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107998729&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104407656 T1 - Breast cancer anxiety's associations with responses to a chemoprevention decision aid. AU - Dillard, Amanda J. AU - Scherer, Laura AU - Ubel, Peter A. AU - Smith, Dylan M. AU - Zikmund-Fisher, Brian J. AU - McClure, Jennifer B. AU - Greene, Sarah AU - Stark, Azadeh AU - Fagerlin, Angela Y1 - 2013/01/15/ N1 - Accession Number: 104407656. Language: English. Entry Date: 20130104. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Allied Health; Biomedical; Continental Europe; Double Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed. Special Interest: Oncologic Care; Social Work; Women's Health. NLM UID: 8303205. KW - Breast Neoplasms -- Psychosocial Factors KW - Anxiety -- Epidemiology KW - Decision Support Techniques -- Evaluation KW - Tamoxifen -- Therapeutic Use KW - Human KW - Female KW - Self Report KW - Secondary Analysis SP - 13 EP - 19 JO - Social Science & Medicine JF - Social Science & Medicine JA - SOC SCI MED VL - 77 PB - Pergamon Press - An Imprint of Elsevier Science AB - Abstract: Few studies have examined how specific emotions may affect decision-making processes. Anxiety may be especially relevant in health decisions such as those related to cancer in which thoughts of illness or death may be abundant. We examined associations between women''s anxiety about developing breast cancer and variables related to their decision to take a medication that could reduce their chances of the disease. Six-hundred and thirty-two American women, who had an increased risk of breast cancer, reviewed a web-based decision aid about tamoxifen. We examined associations between their baseline, self-reported anxiety about developing the disease and post decision aid measures including knowledge about tamoxifen, attitude toward the medication, and behavioral intentions to look for more information and take the medication. Results showed that anxiety was not associated with knowledge about tamoxifen, but it was associated with attitude toward the medication such that women who were more anxious about developing breast cancer were more likely to think the benefits were worth the risks. Greater anxiety was also associated with greater behavioral intentions to look for additional information and take the medication in the next few months. Secondary analyses showed that behavioral intentions were related to knowledge of tamoxifen and attitude toward the medication only for women who were reporting low levels of anxiety. Overall, the findings suggest that anxiety about breast cancer may motivate interest in tamoxifen and not necessarily through affecting knowledge or attitudes. SN - 0277-9536 AD - Department of Psychology, Grand Valley State University, Allendale, MI 49401, USA AD - VA Health Services Research & Development Center of Excellence, VA Ann Arbor Healthcare System, USA; Center for Bioethics and Social Sciences in Medicine, University of Michigan, USA AD - Fuqua School of Business, Duke University, USA; Sanford School of Public Policy, Duke University, USA AD - Department of Preventive Medicine, Stony Brook University, USA AD - Center for Bioethics and Social Sciences in Medicine, University of Michigan, USA; Department of Health Behavior and Health Education, University of Michigan, USA; Department of Internal Medicine, University of Michigan, USA; Risk Science Center, University of Michigan, USA AD - Group Health Research Institute, University of Michigan, USA AD - Henry Ford Health Care System, University of Michigan, USA AD - VA Health Services Research & Development Center of Excellence, VA Ann Arbor Healthcare System, USA; Center for Bioethics and Social Sciences in Medicine, University of Michigan, USA; Department of Internal Medicine, University of Michigan, USA; Department of Psychology, University of Michigan, USA U2 - PMID: 23200299. DO - 10.1016/j.socscimed.2012.10.009 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104407656&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104242999 T1 - On the interplay of machine learning and background knowledge in image interpretation by Bayesian networks. AU - Velikova, Marina AU - Lucas, Peter J F AU - Samulski, Maurice AU - Karssemeijer, Nico Y1 - 2013/01// N1 - Accession Number: 104242999. Language: English. Entry Date: 20130906. Revision Date: 20170411. Publication Type: journal article; research. Journal Subset: Biomedical; Blind Peer Reviewed; Computer/Information Science; Continental Europe; Europe; Expert Peer Reviewed; Peer Reviewed. Special Interest: Informatics. NLM UID: 8915031. KW - Probability KW - Breast Neoplasms -- Radiography KW - Diagnosis, Computer Assisted -- Methods KW - Knowledge Bases KW - Mammography KW - Radiographic Image Interpretation, Computer-Assisted -- Methods KW - Decision Support Systems, Clinical KW - Decision Support Techniques KW - Female KW - Human KW - Models, Theoretical KW - Neural Networks (Computer) KW - Predictive Value of Tests KW - Prognosis SP - 73 EP - 86 JO - Artificial Intelligence in Medicine JF - Artificial Intelligence in Medicine JA - ARTIF INTELL MED VL - 57 IS - 1 PB - Elsevier B.V. AB - Objectives: To obtain a balanced view on the role and place of expert knowledge and learning methods in building Bayesian networks for medical image interpretation. Methods and Materials: The interpretation of mammograms was selected as the example medical image interpretation problem. Medical image interpretation has its own common standards and procedures. The impact of these on two complementary methods for Bayesian network construction was explored. Firstly, methods for the discretisation of continuous features were investigated, yielding multinomial distributions that were compared to the original Gaussian probabilistic parameters of the network. Secondly, the structure of a manually constructed Bayesian network was tested by structure learning from image data. The image data used for the research came from screening mammographic examinations of 795 patients, of whom 344 were cancerous. Results: The experimental results show that there is an interesting interplay of machine learning results and background knowledge in medical image interpretation. Networks with discretised data lead to better classification performance (increase in the detected cancers of up to 11.7%), easier interpretation, and a better fit to the data in comparison to the expert-based Bayesian network with Gaussian probabilistic parameters. Gaussian probability distributions are often used in medical image interpretation because of the continuous nature of many of the image features. The structures learnt supported many of the expert-originated relationships but also revealed some novel relationships between the mammographic features. Using discretised features and performing structure learning on the mammographic data has further improved the cancer detection performance of up to 17% compared to the manually constructed Bayesian network model. Conclusion: Finding the right balance between expert knowledge and data-derived knowledge, both at the level of network structure and parameters, is key to using Bayesian networks for medical image interpretation. A balanced approach to building Bayesian networks for image interpretation yields more accurate and understandable Bayesian network models. SN - 0933-3657 AD - Institute for Computing and Information Sciences, Radboud University Nijmegen, Heyendaalseweg 135, 6525 AJ Nijmegen, The Netherlands. Electronic address: marinav@cs.ru.nl. U2 - PMID: 23395008. DO - 10.1016/j.artmed.2012.12.004 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104242999&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104226454 T1 - Patient and primary care provider experience using a family health history collection, risk stratification, and clinical decision support tool: a type 2 hybrid controlled implementation-effectiveness trial. AU - Wu, R. Ryanne AU - Orlando, Lori A. AU - Himmel, Tiffany L. AU - Buchanan, Adam H. AU - Powell, Karen P. AU - Hauser, Elizabeth R. AU - Agbaje, Astrid B. AU - Henrich, Vincent C. AU - Ginsburg, Geoffrey S. Y1 - 2013/01// N1 - Accession Number: 104226454. Language: English. Entry Date: 20130206. Revision Date: 20150711. Publication Type: Journal Article; clinical trial; research; tables/charts. Journal Subset: Biomedical; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care. Grant Information: This study is funded by the DoD.. NLM UID: 100967792. KW - Primary Health Care KW - Patient History Taking -- Methods KW - Family Health -- Evaluation KW - Decision Making, Clinical -- Methods KW - Data Collection, Computer Assisted KW - Human KW - Funding Source KW - Intervention Trials KW - North Carolina KW - Patient Attitudes KW - Physician Attitudes KW - Neoplasms -- Therapy KW - Thrombosis -- Therapy KW - Data Analysis Software KW - Chi Square Test KW - Analysis of Variance KW - Post Hoc Analysis KW - T-Tests KW - Linear Regression KW - Logistic Regression KW - Odds Ratio KW - Confidence Intervals KW - Male KW - Female KW - Middle Age KW - Aged KW - Descriptive Statistics KW - Physician-Patient Relations KW - Communication KW - Breast Neoplasms KW - Ovarian Neoplasms KW - Colonic Neoplasms SP - 111 EP - 118 JO - BMC Family Practice JF - BMC Family Practice JA - BMC FAM PRACT VL - 14 IS - 1 PB - BioMed Central SN - 1471-2296 AD - Health Services Research and Development, VA Health System, Durham, NC, USA; Duke Center for Personalized Medicine, Duke University, Durham, NC, USA; Duke Department of Internal Medicine, Duke University Health System, Durham, NC, USA AD - Duke Center for Personalized Medicine, Duke University, Durham, NC, USA; Duke Department of Internal Medicine, Duke University Health System, Durham, NC, USA; Institute of Genome Science & Policy, Duke University, Durham, NC, USA AD - Institute of Genome Science & Policy, Duke University, Durham, NC, USA AD - Duke Cancer Institute, Duke University Health System, Durham, NC, USA AD - Center for Biotechnology, Genomics and Health Research, UNC-Greensboro, Greensboro, NC, USA AD - Center for Human Genetics, Duke University, Durham, NC, USA; Durham Epidemiologic Research and Information Center, VA Health System, Durham, NC, USA AD - Cone Health System, Greensboro, NC, USA AD - Duke Center for Personalized Medicine, Duke University, Durham, NC, USA; Institute of Genome Science & Policy, Duke University, Durham, NC, USA DO - 10.1186/1471-2296-14-111 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104226454&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104114921 T1 - Factors influencing the surgery intentions and choices of women with early breast cancer: the predictive utility of an extended theory of planned behaviour. AU - Sivell, Stephanie AU - Elwyn, Glyn AU - Edwards, Adrian AU - Manstead, Antony S R Y1 - 2013/01// N1 - Accession Number: 104114921. Corporate Author: BresDex group. Language: English. Entry Date: 20150227. Revision Date: 20170928. Publication Type: journal article; research. Journal Subset: Biomedical; Computer/Information Science; Europe; UK & Ireland. Special Interest: Informatics. Grant Information: MCCC-FCO-11-C//Marie Curie/United Kingdom. NLM UID: 101088682. KW - Breast Neoplasms -- Psychosocial Factors KW - Breast Neoplasms -- Surgery KW - Mastectomy -- Psychosocial Factors KW - Patient Satisfaction KW - Adult KW - Aged KW - Aged, 80 and Over KW - Breast Neoplasms -- Radiotherapy KW - Decision Making KW - Female KW - Attitude to Health KW - Human KW - Intention KW - Lumpectomy -- Psychosocial Factors KW - Middle Age KW - Neoplasm Staging KW - Psychological Theory SP - 92 EP - 92 JO - BMC Medical Informatics & Decision Making JF - BMC Medical Informatics & Decision Making JA - BMC MED INFORM DECIS MAKING VL - 13 IS - 1 PB - BioMed Central AB - Background: Women diagnosed with early breast cancer (stage I or II) can be offered the choice between mastectomy or breast conservation surgery with radiotherapy due to equivalence in survival rates. A wide variation in the surgical management of breast cancer and a lack of theoretically guided research on this issue highlight the need for further research into the factors influencing women's choices. An extended Theory of Planned Behaviour (TPB) could provide a basis to understand and predict women's surgery choices. The aims of this study were to understand and predict the surgery intentions and choices of women newly diagnosed with early breast cancer, examining the predictive utility of an extended TPB.Methods: Sixty-two women recruited from three UK breast clinics participated in the study; 48 women, newly diagnosed with early breast cancer, completed online questionnaires both before their surgery and after accessing an online decision support intervention (BresDex). Questionnaires assessed views about breast cancer and the available treatment options using items designed to measure constructs of an extended TPB (i.e., attitudes, subjective norms, perceived behavioural control, and anticipated regret), and women's intentions to choose mastectomy or BCS. Objective data were collected on women's choice of surgery via the clinical breast teams. Multiple and logistic regression analyses examined predictors of surgery intentions and subsequent choice of surgery.Results: The extended TPB accounted for 69.9% of the variance in intentions (p <.001); attitudes and subjective norms were significant predictors. Including additional variables revealed anticipated regret to be a more important predictor than subjective norms. Surgery intentions significantly predicted surgery choices (p <.01).Conclusions: These findings demonstrate the utility of an extended TPB in predicting and understanding women's surgery intentions and choices for early breast cancer. Understanding these factors should help to identify key components of interventions to support women while considering their surgery options. SN - 1472-6947 AD - Marie Curie Palliative Care Research Centre, Wales Cancer Trials Unit, Cardiff University School of Medicine, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK. sivells2@cf.ac.uk. U2 - PMID: 23962230. DO - 10.1186/1472-6947-13-92 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104114921&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104008324 T1 - An improved survivability prognosis of breast cancer by using sampling and feature selection technique to solve imbalanced patient classification data. AU - Wang, Kung-Jeng AU - Makond, Bunjira AU - Wang, Kung-Min Y1 - 2013/01// N1 - Accession Number: 104008324. Language: English. Entry Date: 20150227. Revision Date: 20170508. Publication Type: journal article; research. Journal Subset: Biomedical; Computer/Information Science; Europe; UK & Ireland. Special Interest: Informatics. NLM UID: 101088682. KW - Breast Neoplasms -- Mortality KW - Models, Statistical KW - Prognosis KW - Adult KW - Classification -- Methods KW - Decision Trees KW - Female KW - Human KW - Logistic Regression SP - 124 EP - 124 JO - BMC Medical Informatics & Decision Making JF - BMC Medical Informatics & Decision Making JA - BMC MED INFORM DECIS MAKING VL - 13 IS - 1 PB - BioMed Central AB - Background: Breast cancer is one of the most critical cancers and is a major cause of cancer death among women. It is essential to know the survivability of the patients in order to ease the decision making process regarding medical treatment and financial preparation. Recently, the breast cancer data sets have been imbalanced (i.e., the number of survival patients outnumbers the number of non-survival patients) whereas the standard classifiers are not applicable for the imbalanced data sets. The methods to improve survivability prognosis of breast cancer need for study.Methods: Two well-known five-year prognosis models/classifiers [i.e., logistic regression (LR) and decision tree (DT)] are constructed by combining synthetic minority over-sampling technique (SMOTE), cost-sensitive classifier technique (CSC), under-sampling, bagging, and boosting. The feature selection method is used to select relevant variables, while the pruning technique is applied to obtain low information-burden models. These methods are applied on data obtained from the Surveillance, Epidemiology, and End Results database. The improvements of survivability prognosis of breast cancer are investigated based on the experimental results.Results: Experimental results confirm that the DT and LR models combined with SMOTE, CSC, and under-sampling generate higher predictive performance consecutively than the original ones. Most of the time, DT and LR models combined with SMOTE and CSC use less informative burden/features when a feature selection method and a pruning technique are applied.Conclusions: LR is found to have better statistical power than DT in predicting five-year survivability. CSC is superior to SMOTE, under-sampling, bagging, and boosting to improve the prognostic performance of DT and LR. SN - 1472-6947 AD - Department of Industrial Management, National Taiwan University of Science and Technology, Taipei 106, Taiwan. kjwang@mail.ntust.edu.tw. U2 - PMID: 24207108. DO - 10.1186/1472-6947-13-124 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104008324&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104401594 T1 - Standalone computer-aided detection compared to radiologists' performance for the detection of mammographic masses. AU - Hupse R AU - Samulski M AU - Lobbes M AU - den Heeten A AU - Imhof-Tas MW AU - Beijerinck D AU - Pijnappel R AU - Boetes C AU - Karssemeijer N AU - Hupse, Rianne AU - Samulski, Maurice AU - Lobbes, Marc AU - den Heeten, Ard AU - Imhof-Tas, Mechli W AU - Beijerinck, David AU - Pijnappel, Ruud AU - Boetes, Carla AU - Karssemeijer, Nico Y1 - 2013/01// N1 - Accession Number: 104401594. Language: English. Entry Date: 20130607. Revision Date: 20170930. Publication Type: journal article; research. Journal Subset: Biomedical; Continental Europe; Double Blind Peer Reviewed; Europe; Peer Reviewed. Special Interest: Diagnostic Imaging. NLM UID: 9114774. KW - Breast Neoplasms -- Radiography KW - Clinical Competence KW - Mammography -- Methods KW - Radiographic Image Interpretation, Computer-Assisted -- Methods KW - Aged KW - Decision Support Systems, Clinical KW - False Negative Results KW - False Positive Results KW - Female KW - Human KW - Health Screening KW - Middle Age KW - Netherlands KW - Retrospective Design KW - Sensitivity and Specificity SP - 93 EP - 100 JO - European Radiology JF - European Radiology JA - EUR RADIOL VL - 23 IS - 1 CY - , PB - Springer Science & Business Media B.V. AB - Objectives: We developed a computer-aided detection (CAD) system aimed at decision support for detection of malignant masses and architectural distortions in mammograms. The effect of this system on radiologists' performance depends strongly on its standalone performance. The purpose of this study was to compare the standalone performance of this CAD system to that of radiologists.Methods: In a retrospective study, nine certified screening radiologists and three residents read 200 digital screening mammograms without the use of CAD. Performances of the individual readers and of CAD were computed as the true-positive fraction (TPF) at a false-positive fraction of 0.05 and 0.2. Differences were analysed using an independent one-sample t-test.Results: At a false-positive fraction of 0.05, the performance of CAD (TPF = 0.487) was similar to that of the certified screening radiologists (TPF = 0.518, P = 0.17). At a false-positive fraction of 0.2, CAD performance (TPF = 0.620) was significantly lower than the radiologist performance (TPF = 0.736, P <0.001). Compared to the residents, CAD performance was similar for all false-positive fractions.Conclusions: The sensitivity of CAD at a high specificity was comparable to that of human readers. These results show potential for CAD to be used as an independent reader in breast cancer screening. SN - 0938-7994 AD - Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands AD - Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands, a.hupse@rad.umcn.nl. U2 - PMID: 22772149. DO - 10.1007/s00330-012-2562-7 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104401594&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107914327 T1 - Gene expression profiling and expanded immunohistochemistry tests to guide the use of adjuvant chemotherapy in breast cancer management: a systematic review and cost-effectiveness analysis. AU - Ward, S AU - Scope, A AU - Rafia, R AU - Pandor, A AU - Harnan, S AU - Evans, P AU - Wyld, L Y1 - 2013/01//2013 Aug N1 - Accession Number: 107914327. Language: English. Entry Date: 20140418. Revision Date: 20150712. Publication Type: Journal Article; research; systematic review. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. Special Interest: Evidence-Based Practice. NLM UID: 9706284. KW - Antineoplastic Agents -- Therapeutic Use KW - Breast Neoplasms -- Drug Therapy KW - Gene Expression Profiling -- Economics KW - Gene Expression Profiling -- Methods KW - Antineoplastic Agents -- Economics KW - Breast Neoplasms KW - Breast Neoplasms -- Diagnosis KW - Breast Neoplasms -- Economics KW - Chemotherapy, Adjuvant -- Economics KW - Chemotherapy, Adjuvant -- Methods KW - Cochrane Library KW - Cost Benefit Analysis KW - Embase KW - Female KW - Human KW - Immunohistochemistry KW - Medline KW - Prognosis KW - Systematic Review KW - Treatment Outcomes SP - 1 EP - 302 JO - Health Technology Assessment JF - Health Technology Assessment JA - HEALTH TECHNOL ASSESS VL - 17 IS - 32 PB - NIHR Journals Library AB - BACKGROUND: Gene expression profiling (GEP) and expanded immunohistochemistry (IHC) tests aim to improve decision-making relating to adjuvant chemotherapy for women with early breast cancer. OBJECTIVE: The aim of this report is to assess the clinical effectiveness and cost-effectiveness of nine GEP and expanded IHC tests compared with current prognostic tools in guiding the use of adjuvant chemotherapy in patients with early breast cancer in England and Wales. The nine tests are BluePrint, Breast Cancer Index (BCI), IHC4, MammaPrint, Mammostrat, NPI plus (NPI+), OncotypeDX, PAM50 and Randox Breast Cancer Array. DATA SOURCES: Databases searched included MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE and The Cochrane Library. Databases were searched from January 2009 to May 2011 for the OncotypeDX and MammaPrint tests and from January 2002 to May 2011 for the other tests. REVIEW METHODS: A systematic review of the evidence on clinical effectiveness (analytical validity, clinical validity and clinical utility) and cost-effectiveness was conducted. An economic model was developed to evaluate the cost-effectiveness of adjuvant chemotherapy treatment guided by four of the nine test (OncotypeDX, IHC4, MammaPrint and Mammostrat) compared with current clinical practice in England and Wales, using clinicopathological parameters, in women with oestrogen receptor-positive (ER+), lymph node-negative (LN-), human epidermal growth factor receptor type 2-negative (HER2-) early breast cancer. RESULTS: The literature searches for clinical effectiveness identified 5993 citations, of which 32 full-text papers or abstracts (30 studies) satisfied the criteria for the effectiveness review. A narrative synthesis was performed. Evidence for OncotypeDX supported the prognostic capability of the test. There was some evidence on the impact of the test on decision-making and to support the case that OncotypeDX predicts chemotherapy benefit; however, few studies were UK based and limitations in relation to study design were identified. Evidence for MammaPrint demonstrated that the test score was a strong independent prognostic factor, but the evidence is non-UK based and is based on small sample sizes. Evidence on the Mammostrat test showed that the test was an independent prognostic tool for women with ER+, tamoxifen-treated breast cancer. The three studies appeared to be of reasonable quality and provided data from a UK setting (one study). One large study reported on clinical validity of the IHC4 test, with IHC4 score a highly significant predictor of distant recurrence. This study included data from a UK setting and appeared to be of reasonable quality. Evidence for the remaining five tests (PAM50, NPI+, BCI, BluePrint and Randox) was limited. The economic analysis suggests that treatment guided using IHC4 has the greatest potential to be cost-effective at a £20,000 threshold, given the low cost of the test; however, further research is needed on the analytical validity and clinical utility of IHC4, and the exact cost of the test needs to be confirmed. Current limitations in the evidence base produce significant uncertainty in the results. OncotypeDX has a more robust evidence base, but further evidence on its impact on decision-making in the UK and the predictive ability of the test in an ER+, LN-, HER- population receiving current drug regimens is needed. For MammaPrint and Mammostrat there were significant gaps in the available evidence and the estimates of cost-effectiveness produced were not considered to be robust by the External Assessment Group. LIMITATIONS: Methodological weaknesses in the clinical evidence base relate to heterogeneity of patient cohorts and issues arising from the retrospective nature of the evidence. Further evidence is required on the clinical utility of all of the tests and on UK-based populations. A key area of uncertainty relates to whether the tests provide prognostic or predictive ability. CONCLUSIONS: The clinical evidence base for OncotypeDX is considered to be the most robust. The economic analysis suggested that treatment guided using IHC4 has the most potential to be cost-effective at a threshold of £20,000; however, the evidence base to support IHC4 needs significant further research. STUDY REGISTRATION: PROSPERO 2011:CRD42011001361, available from www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD4201100136 1. FUNDING: The National Institute for Health Research Health Technology Assessment programme. SN - 1366-5278 AD - School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK. U2 - PMID: 24088296. DO - 10.3310/hta17440 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107914327&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104411109 T1 - How to Discriminate between Computer-Aided and Computer-Hindered Decisions: A Case Study in Mammography. AU - Povyakalo, Andrey A. AU - Alberdi, Eugenio AU - Strigini, Lorenzo AU - Ayton, Peter Y1 - 2013/01// N1 - Accession Number: 104411109. Language: English. Entry Date: 20130111. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Informatics; Oncologic Care; Women's Health. Grant Information: This work was supported in part by the UK Engineering and Physical Sciences Research Council (EPSRC) through projects DIRC (the Dependability Interdisciplinary Research Collaboration) and INDEED (‘‘Interdisciplinary Design and Evaluation of Dependability,’’ EP/E000517/1) as well as by Cancer Research UK (grant GR/ C22515/A7339).. NLM UID: 8109073. KW - Decision Support Techniques -- Evaluation KW - Breast Neoplasms -- Diagnosis KW - Cancer Screening -- Evaluation KW - Decision Making, Clinical -- Evaluation KW - Funding Source KW - Human KW - Female KW - Step-Wise Multiple Regression KW - Descriptive Statistics KW - Confidence Intervals KW - P-Value KW - Sensitivity and Specificity SP - 98 EP - 107 JO - Medical Decision Making JF - Medical Decision Making JA - MED DECIS MAKING VL - 33 IS - 1 CY - Thousand Oaks, California PB - Sage Publications Inc. SN - 0272-989X U2 - PMID: 23300205. DO - 10.1177/0272989X12465490 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104411109&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 108029253 T1 - Computer-aided detection of masses at mammography: interactive decision support versus prompts. AU - Hupse R AU - Samulski M AU - Lobbes MB AU - Mann RM AU - Mus R AU - den Heeten GJ AU - Beijerinck D AU - Pijnappel RM AU - Boetes C AU - Karssemeijer N AU - Hupse, Rianne AU - Samulski, Maurice AU - Lobbes, Marc B AU - Mann, Ritse M AU - Mus, Roel AU - den Heeten, Gerard J AU - Beijerinck, David AU - Pijnappel, Ruud M AU - Boetes, Carla AU - Karssemeijer, Nico Y1 - 2013/01//2013 Jan N1 - Accession Number: 108029253. Language: English. Entry Date: 20130222. Revision Date: 20170404. Publication Type: journal article; research. Journal Subset: Biomedical; USA. Special Interest: Diagnostic Imaging. NLM UID: 0401260. KW - Breast Neoplasms -- Epidemiology KW - Breast Neoplasms -- Radiography KW - Mammography -- Statistics and Numerical Data KW - Radiographic Image Interpretation, Computer-Assisted -- Methods KW - User-Computer Interface KW - Aged KW - Decision Support Systems, Clinical KW - Female KW - Human KW - Middle Age KW - Netherlands KW - Prevalence KW - Reproducibility of Results KW - Risk Assessment KW - Sensitivity and Specificity SP - 123 EP - 129 JO - Radiology JF - Radiology JA - RADIOLOGY VL - 266 IS - 1 CY - Oak Brook, Illinois PB - Radiological Society of North America AB - Purpose: To compare effectiveness of an interactive computer-aided detection (CAD) system, in which CAD marks and their associated suspiciousness scores remain hidden unless their location is queried by the reader, with the effect of traditional CAD prompts used in current clinical practice for the detection of malignant masses on full-field digital mammograms. Materials and Methods: The requirement for institutional review board approval was waived for this retrospective observer study. Nine certified screening radiologists and three residents who were trained in breast imaging read 200 studies (63 studies containing at least one screen-detected mass, 17 false-negative studies, 20 false-positive studies, and 100 normal studies) twice, once with CAD prompts and once with interactive CAD. Localized findings were reported and scored by the readers. In the prompted mode, findings were recorded before and after activation of CAD. The partial area under the location receiver operating characteristic (ROC) curve for an interval of low false-positive fractions typical for screening, from 0 to 0.2, was computed for each reader and each mode. Differences in reader performance were analyzed by using software. Results: The average partial area under the location ROC curve with unaided reading was 0.57, and it increased to 0.62 with interactive CAD, while it remained unaffected by prompts. The difference in reader performance for unaided reading versus interactive CAD was statistically significant (P = .009). Conclusion: When used as decision support, interactive use of CAD for malignant masses on mammograms may be more effective than the current use of CAD, which is aimed at the prevention of perceptual oversights. SN - 0033-8419 AD - Department of Radiology, Diagnostic Image Analysis Group, Radboud University Nijmegen Medical Centre, Geert Grooteplein-Zuid 10, Route 667, Postbus 9101, 6500 HB Nijmegen, The Netherlands U2 - PMID: 23091171. DO - 10.1148/radiol.12120218 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=108029253&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104165291 T1 - Pre-consultation educational group intervention to improve shared decision-making in postmastectomy breast reconstruction: study protocol for a pilot randomized controlled trial. AU - Platt, Jennica AU - Baxter, Nancy AU - Jones, Jennifer AU - Metcalfe, Kelly AU - Causarano, Natalie AU - Hofer, Stefan O P AU - O'Neill, Anne AU - Cheng, Terry AU - Starenkyj, Elizabeth AU - Zhong, Toni Y1 - 2013/01// N1 - Accession Number: 104165291. Language: English. Entry Date: 20141024. Revision Date: 20161222. Publication Type: journal article; research; randomized controlled trial. Journal Subset: Biomedical; Europe; UK & Ireland. Grant Information: //Canadian Institutes of Health Research/Canada. NLM UID: 101263253. KW - Breast Implants KW - Breast Neoplasms -- Surgery KW - Decision Making KW - Attitude to Health KW - Mastectomy KW - Patient Education KW - Referral and Consultation KW - Study Design KW - Breast Neoplasms -- Diagnosis KW - Breast Neoplasms -- Psychosocial Factors KW - Protocols KW - Pilot Studies KW - Female KW - Human KW - Ontario KW - Consumer Participation KW - Patient Satisfaction KW - Self-Efficacy KW - Treatment Outcomes SP - 199 EP - 199 JO - Trials JF - Trials JA - TRIALS VL - 14 IS - 1 PB - BioMed Central AB - Background: The Pre-Consultation Educational Group INTERVENTION pilot study seeks to assess the feasibility and inform the optimal design for a definitive randomized controlled trial that aims to improve the quality of decision-making in postmastectomy breast reconstruction patients.Methods/design: This is a mixed-methods pilot feasibility randomized controlled trial that will follow a single-center, 1:1 allocation, two-arm parallel group superiority design.Setting: The University Health Network, a tertiary care cancer center in Toronto, Canada.Participants: Adult women referred to one of three plastic and reconstructive surgeons for delayed breast reconstruction or prophylactic mastectomy with immediate breast reconstruction.Intervention: We designed a multi-disciplinary educational group workshop that incorporates the key components of shared decision-making, decision-support, and psychosocial support for cancer survivors prior to the initial surgical consult. The intervention consists of didactic lectures by a plastic surgeon and nurse specialist on breast reconstruction choices, pre- and postoperative care; a value-clarification exercise led by a social worker; and discussions with a breast reconstruction patient.Control: Usual care includes access to an informational booklet, website, and patient volunteer if desired.Outcomes: Expected pilot outcomes include feasibility, recruitment, and retention targets. Acceptability of intervention and full trial outcomes will be established through qualitative interviews. Trial outcomes will include decision-quality measures, patient-reported outcomes, and service outcomes, and the treatment effect estimate and variability will be used to inform the sample size calculation for a full trial.Discussion: Our pilot study seeks to identify the (1) feasibility, acceptability, and design of a definitive RCT and (2) the optimal content and delivery of our proposed educational group intervention. Thirty patients have been recruited to date (8 April 2013), of whom 15 have been randomized to one of three decision support workshops. The trial will close as planned in May 2013.Trial Registration: NCT01857882. SN - 1745-6215 AD - UHN Breast Restoration Program, Division of Plastic and Reconstructive Surgery, 8N 871, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada. U2 - PMID: 23829442. DO - 10.1186/1745-6215-14-199 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104165291&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104115969 T1 - WSG ADAPT - adjuvant dynamic marker-adjusted personalized therapy trial optimizing risk assessment and therapy response prediction in early breast cancer: study protocol for a prospective, multi-center, controlled, non-blinded, randomized, investigator initiated phase II/III trial. AU - Hofmann, Daniel AU - Nitz, Ulrike AU - Gluz, Oleg AU - Kates, Ronald E AU - Schinkoethe, Timo AU - Staib, Peter AU - Harbeck, Nadia Y1 - 2013/01// N1 - Accession Number: 104115969. Language: English. Entry Date: 20141024. Revision Date: 20161222. Publication Type: journal article; research; randomized controlled trial. Journal Subset: Biomedical; Europe; UK & Ireland. NLM UID: 101263253. KW - Antineoplastic Agents, Combined -- Therapeutic Use KW - Breast Neoplasms -- Therapy KW - Decision Support Techniques KW - Individualized Medicine KW - Neoadjuvant Therapy -- Adverse Effects KW - Study Design KW - Tumor Markers, Biological -- Analysis KW - Antineoplastic Agents, Combined -- Adverse Effects KW - Biopsy KW - Breast Neoplasms -- Pathology KW - Chemotherapy, Adjuvant KW - Early Detection of Cancer KW - Female KW - Germany KW - Human KW - Patient Selection KW - Predictive Value of Tests KW - Prospective Studies KW - Protocols KW - Randomized Controlled Trials KW - Receptors, Cell Surface -- Analysis KW - Risk Assessment KW - Risk Factors KW - Time Factors KW - Treatment Outcomes SP - 261 EP - 261 JO - Trials JF - Trials JA - TRIALS VL - 14 IS - 1 PB - BioMed Central AB - Background: Adjuvant treatment decision-making based on conventional clinical/pathological and prognostic single molecular markers or genomic signatures is a therapeutic area in which over-/under-treatment are still key clinical problems even though substantial and continuous improvement of outcome has been achieved over the past decades. Response to therapy is currently not considered in the decision-making procedure.ADAPT is one of the first new generation (neo)adjuvant trials dealing with individualization of (neo)adjuvant decision-making in early breast cancer and aims to establish early predictive surrogate markers, e.g., Ki-67, for therapy response under a short induction treatment in order to maximally individualize therapy and avoid unnecessary toxicity by ineffective treatment.Methods/design: The prospective, multi-center, controlled, non-blinded, randomized, investigator initiated phase II/III ADAPT trial has an innovative "umbrella" protocol design. The "umbrella" is common for all patients, consisting of dynamic testing of early therapy response. ADAPT will recruit 4,936 patients according to their respective breast cancer subtype in four distinct sub-trials at 80 trial sites in Germany; 4,000 patients with hormone receptor positive (HR+) and HER2 negative disease will be included in the ADAPT HR+/HER2- sub-trial, where treatment decision is based on risk assessment and therapy response to induction therapy, and 380 patients will be included in ADAPT HER2+/HR+. A further 220 patients will be included in ADAPT HER2+/HR- and 336 patients will be recruited for ADAPT Triple Negative. These three sub-trials focus on identification of early surrogate markers for therapy success in the neoadjuvant setting. Patients will be allocated to the respective sub-trial according to the result of their diagnostic core biopsy, as reported by local/central pathology for HR and HER2 status.Discussion: Recent trials, such as the GeparTrio, have shown that response-guided therapy using clinical response may improve outcome. For chemotherapy or HER2-targeted treatment, pathologic complete response in a neoadjuvant setting is an excellent predictor of outcome. For endocrine therapy, response to short induction treatment - as defined by decrease in tumor cell proliferation - strongly correlates with outcome. ADAPT now aims to combine static prognostic and dynamic predictive markers, focusing not just on single therapeutic targets, but also on general markers of proliferation and cell death. Biomarker analysis will help to optimize selection of subtype-specific treatment.Trial Registration: ClinicalTrials.gov: ADAPT Umbrella: NCT01781338; ADAPT HR+/HER2-: NCT01779206; ADAPT HER2+/HR+: NCT01745965; ADAPT HER2+/HR-: NCT01817452; ADAPT TN:NCT01815242. SN - 1745-6215 AD - West German Study Group, Ludwig-Weber-Str, 15b, 41061 Moenchengladbach, Germany. daniel.hofmann@wsg-online.com. U2 - PMID: 23958221. DO - 10.1186/1745-6215-14-261 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104115969&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104392826 T1 - Physician behaviors surrounding the implementation of decision and communication AIDS in a breast cancer clinic: a qualitative analysis of staff intern perceptions. AU - Pass M AU - Volz S AU - Teng A AU - Esserman L AU - Belkora J AU - Pass, M AU - Volz, S AU - Teng, A AU - Esserman, L AU - Belkora, J Y1 - 2012/12// N1 - Accession Number: 104392826. Language: English. Entry Date: 20130614. Revision Date: 20171115. Publication Type: journal article; research. Journal Subset: Biomedical; Blind Peer Reviewed; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Health Promotion/Education; Peer Reviewed; USA. Special Interest: Oncologic Care. NLM UID: 8610343. KW - Attitude of Health Personnel KW - Breast Neoplasms -- Prevention and Control KW - Communication Barriers KW - Decision Making KW - Internship and Residency KW - Patient Care -- Psychosocial Factors KW - Practice Patterns KW - Breast Neoplasms -- Diagnosis KW - Data Collection KW - Education, Medical -- Standards KW - Female KW - Human KW - Learning KW - Perception KW - Qualitative Studies KW - Questionnaires KW - Referral and Consultation SP - 764 EP - 769 JO - Journal of Cancer Education JF - Journal of Cancer Education JA - J CANCER EDUC VL - 27 IS - 4 CY - , PB - Springer Science & Business Media B.V. AB - The aim of this paper is to examine how physician behavior facilitated or impeded our implementation of decision and communication aids in a breast cancer clinic. Staff interns provided decision and communication aids to patients and wrote up case notes for each patient they served. We used grounded theory to code our staff interns' case notes. We then identified barriers and facilitators to our program's implementation from each category we generated in the coding. Facilitators included physicians reading patient questions and then bringing the staff interns to the consultation. Barriers included physicians forgetting to bring the staff interns to the appointments and discouraging interns from speaking during the consultation. Physicians vary in their cooperation with our program. Our next steps will be to inquire directly with physicians about how to adapt our program design. We will also seek to position the staff interns as mentees to increase physician commitment to our program. SN - 0885-8195 AD - Philip R. Lee Institute For Health Policy Studies, University of California, San Francisco, San Francisco, CA 94118, USA AD - Philip R. Lee Institute For Health Policy Studies, University of California, San Francisco, 3333 California St, Suite 265, San Francisco, CA, 94118, USA. U2 - PMID: 22923382. DO - 10.1007/s13187-012-0402-8 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104392826&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104424943 T1 - A Delphi consensus study among patients and clinicians in the Netherlands on the procedure of informing young breast cancer patients about Fertility Preservation. AU - Garvelink, Mirjam M. AU - ter Kuile, Moniek M. AU - Louw, Leoni A. AU - Hilders, Carina G. J. M. AU - Stiggelbout, Anne M. Y1 - 2012/11// N1 - Accession Number: 104424943. Language: English. Entry Date: 20121012. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Continental Europe; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed. Special Interest: Oncologic Care; Women's Health. NLM UID: 8709065. KW - Breast Neoplasms -- Complications -- Netherlands KW - Decision Making, Patient -- Methods KW - Fertility -- Psychosocial Factors KW - Access to Information KW - Netherlands KW - Human KW - Female KW - Adult KW - Fisher's Exact Test KW - Descriptive Statistics KW - Data Analysis Software KW - Middle Age KW - Male KW - Focus Groups KW - Health Personnel KW - Cancer Patients KW - Summated Rating Scaling KW - Feedback SP - 1062 EP - 1069 JO - Acta Oncologica JF - Acta Oncologica JA - ACTA ONCOL VL - 51 IS - 8 CY - Philadelphia, Pennsylvania PB - Taylor & Francis Ltd AB - Background. The aim of this study was to obtain feedback from, and reach consensus among different experts who are or have been involved in information provision about FP, regarding the (procedure of) information provision about Fertility Preservation (FP) and use of a web-based decision aid (DA) about FP to create optimal conditions for the implementation of the DA-website, as we prepare to implement a DA about FP in the Netherlands. Material and methods. A two round Delphi study in which experts (patients and clinicians) rated their (dis)agreement with a list of statements (Rounds 1, 2), and additional online forum to discuss dissensus (Round 3). We assessed opinions about FP, web-based DAs, and about the procedure of informing patients. Answer categories ranged from 1 (totally disagree) to 5 (totally agree). Consensus was considered significant when at least 80% of the experts scored either the lowest or the highest two categories. Results. Experts reached rapid consensus on all five statements about the use of a DA (5/5; 100%), and all eight statements about which patients should be offered information about FP (8/8; 100%). However opinions about FP (4/11 statements; 36%), and procedural aspects such as who should inform the patient (6/10 statements; 60%) and when (3/10 statements; 30%) remained for discussion in round 3. In the online discussion some level of agreement was reached for these statements after all. Conclusion. It was deemed important that FP options exist. Every eligible patient should receive at least some (general) information about FP, soon after diagnosis. Detailed information should be provided by a fertility expert at a later moment. Exact timing and amount of information should be adjusted to patient's needs and situational context. A DA-website can offer a fair contribution to this. SN - 0284-186X AD - Department of Gynecology, Leiden University Medical Center (LUMC), the Netherlands AD - Department of Gynecology, Reinier de Graaf Groep, Delft, the Netherlands AD - Department of Medical Decision Making, LUMC, the Netherlands U2 - PMID: 23050612. DO - 10.3109/0284186X.2012.702927 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104424943&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104275689 T1 - Optimizing canadian breast cancer screening strategies: aperspective for action. AU - Barisic, Andriana AU - Taghipour, Sharareh AU - Banjevic, Dragan AU - Miller, Anthony B AU - Montgomery, Neil AU - Jardine, Andrew AU - Harvey, Bart J Y1 - 2012/11//Nov/Dec2012 N1 - Accession Number: 104275689. Language: English. Entry Date: 20130920. Revision Date: 20150711. Publication Type: Journal Article. Journal Subset: Biomedical; Canada; Double Blind Peer Reviewed; Expert Peer Reviewed; Peer Reviewed; Public Health. Special Interest: Public Health. NLM UID: 0372714. KW - Breast Neoplasms -- Prevention and Control KW - Computer Simulation KW - Early Detection of Cancer KW - Health Policy KW - Aged KW - Canada KW - Decision Support Techniques KW - Dissent and Disputes KW - Female KW - Middle Age KW - Practice Guidelines SP - e417 EP - 9 JO - Canadian Journal of Public Health JF - Canadian Journal of Public Health JA - CAN J PUBLIC HEALTH VL - 103 IS - 6 CY - Ottawa, Ontario PB - Canadian Public Health Association AB - While controversies regarding optimal breast cancer screening modalities, screening start and end ages, and screening frequencies continue to exist, additional population-based randomized trials are unlikely to be initiated to examine these concerns. Simulation models have been used to evaluate the efficacy and effectiveness of various breast cancer screening strategies, however these models were all developed using US data. Currently, there is a need to examine the optimal screening and treatment policies in the Canadian context. In this commentary, we discuss the current controversies pertaining to breast cancer screening, and describe the fundamental components of a simulation model, which can be used to inform breast cancer screening and treatment policies. SN - 0008-4263 AD - Ryerson University University of Toronto. sharareh@mie.utoronto.ca. U2 - PMID: 23618019. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104275689&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104383765 T1 - Cognitive errors and logistical breakdowns contributing to missed and delayed diagnoses of breast and colorectal cancers: a process analysis of closed malpractice claims. AU - Poon EG AU - Kachalia A AU - Puopolo AL AU - Gandhi TK AU - Studdert DM AU - Poon, Eric G AU - Kachalia, Allen AU - Puopolo, Ann Louise AU - Gandhi, Tejal K AU - Studdert, David M Y1 - 2012/11// N1 - Accession Number: 104383765. Language: English. Entry Date: 20130503. Revision Date: 20161117. Publication Type: journal article; research. Journal Subset: Biomedical; Continental Europe; Europe. Grant Information: HS011886-03/HS/AHRQ HHS/United States. NLM UID: 8605834. KW - Breast Neoplasms -- Diagnosis KW - Colorectal Neoplasms -- Diagnosis KW - Diagnosis, Delayed -- Statistics and Numerical Data KW - Diagnostic Errors -- Statistics and Numerical Data KW - Malpractice -- Statistics and Numerical Data KW - Adult KW - Cognition KW - Decision Support Techniques KW - Diagnosis, Delayed KW - Diagnosis, Delayed -- Psychosocial Factors KW - Diagnostic Errors -- Prevention and Control KW - Diagnostic Errors -- Psychosocial Factors KW - Female KW - Male KW - Middle Age SP - 1416 EP - 1423 JO - JGIM: Journal of General Internal Medicine JF - JGIM: Journal of General Internal Medicine JA - J GEN INTERN MED VL - 27 IS - 11 CY - , PB - Springer Science & Business Media B.V. AB - Purpose: To erform a process analysis of missed and delayed diagnoses of breast and colorectal cancers to identify: (1) the cognitive and logistical factors that lead to these diagnostic errors, and (2) prevention strategies.Methods: Using 56 cases (43 breast, 13 colon) of missed and delayed diagnosis, we performed structured analyses to identify specific points in the diagnostic process in which errors occurred. Each error was classified as either a cognitive error or logistical breakdown. Finally, two physician-investigators identified strategies to prevent the errors in each case.Results: Virtually all cases involved one or more cognitive errors (53/56, 95 %) and approximately half (31/56, 55 %) involved logistical breakdowns. The clinical activity most prone to cognitive error was the selection of the diagnostic strategy, both during the office visit (25/56, 45 %) and during interpretation of test results (22/50, 44 %). Arrangement of follow-up visits with a primary care physician (8/29, 28 %) or specialist physician (7/29, 26 %) were especially prone to logistical breakdowns. Adherence to current clinical guidelines could have prevented at least one error in 66 % of cases and assistance from a patient advocate could have prevented at least one error in 48 % of cases.Conclusions: Cognitive errors and logistical breakdowns are common among missed and delayed diagnoses of breast and colorectal cancers. Prevention strategies should focus on ensuring improving the effectiveness and use of clinical guidelines in the selection of diagnostic strategy, both during office visits and when interpreting test results. Tools to facilitate communication and to ensure that follow-up visits occur should also be considered. SN - 0884-8734 AD - Division of General Medicine and Primary Care, Department of Medicine, Brigham & Women's Hospital, 3/F 1620 Tremont Street, Boston, MA, 02120, USA AD - Division of General Medicine and Primary Care, Department of Medicine, Brigham & Women's Hospital, 3/F 1620 Tremont Street, Boston, MA, 02120, USA, epoon@partners.org. U2 - PMID: 22610909. DO - 10.1007/s11606-012-2107-4 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104383765&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104361474 T1 - Accuracy of clinical data entry when using a computerized decision support system: a case study with OncoDoc2. AU - Séroussi, Brigitte AU - Blaszka-Jaulerry, Brigitte AU - Zelek, Laurent AU - Lefranc, Jean-Pierre AU - Conforti, Rosa AU - Spano, Jean-Philippe AU - Rousseau, Alexandra AU - Bouaud, Jacques Y1 - 2012/11// N1 - Accession Number: 104361474. Language: English. Entry Date: 20130322. Revision Date: 20150711. Publication Type: Journal Article; pictorial; research; tables/charts. Journal Subset: Computer/Information Science; Continental Europe; Editorial Board Reviewed; Europe; Peer Reviewed. Special Interest: Informatics; Oncologic Care. NLM UID: 9214582. KW - Breast Neoplasms -- Therapy KW - Electronic Health Records KW - Data Management KW - Decision Support Systems, Clinical KW - Case Studies KW - Human KW - Reproducibility of Results KW - Sensitivity and Specificity SP - 472 EP - 476 JO - Studies in Health Technology & Informatics JF - Studies in Health Technology & Informatics JA - STUD HEALTH TECHNOL INFORM VL - 180 PB - IOS Press SN - 0926-9630 AD - UPMC, UFR de Médecine, Paris, France. U2 - PMID: 22874235. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104361474&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104369193 T1 - Patient navigation for breast and colorectal cancer in 3 community hospital settings: An economic evaluation. AU - Donaldson EA AU - Holtgrave DR AU - Duffin RA AU - Feltner F AU - Funderburk W AU - Freeman HP Y1 - 2012/10// N1 - Accession Number: 104369193. Language: English. Entry Date: 20130111. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Oncologic Care. NLM UID: 0374236. KW - Breast Neoplasms -- Economics KW - Colorectal Neoplasms -- Economics KW - Data Analysis, Statistical KW - Health Care Costs -- Statistics and Numerical Data KW - Hospitals, Community -- Economics KW - Health Screening -- Economics KW - Medically Underserved Area KW - Adult KW - Aged KW - Biopsy -- Economics KW - Breast Neoplasms -- Epidemiology KW - Colonoscopy -- Economics KW - Colorectal Neoplasms -- Epidemiology KW - Cost Benefit Analysis KW - Decision Support Techniques KW - Female KW - Health Services Accessibility KW - Hospitals, Community -- Statistics and Numerical Data KW - Human KW - Male KW - Mammography -- Economics KW - Health Screening -- Methods KW - Middle Age KW - Poverty -- Economics KW - United States SP - 4851 EP - 4859 JO - Cancer (0008543X) JF - Cancer (0008543X) JA - CANCER VL - 118 IS - 19 CY - Hoboken, New Jersey PB - John Wiley & Sons, Inc. SN - 0008-543X AD - Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. edonalds@jhsph.edu. U2 - PMID: 22392629. DO - 10.1002/cncr.27487 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104369193&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104355708 T1 - Stopping tamoxifen peri-operatively for VTE risk reduction: A proposed management algorithm. AU - Hussain, Tasadooq AU - Kneeshaw, Peter J Y1 - 2012/10// N1 - Accession Number: 104355708. Language: English. Entry Date: 20130111. Revision Date: 20150711. Publication Type: Journal Article. Journal Subset: Biomedical; USA. Special Interest: Perioperative Care. NLM UID: 101228232. KW - Antineoplastic Agents, Hormonal -- Administration and Dosage KW - Breast Neoplasms -- Drug Therapy KW - Decision Support Techniques KW - Perioperative Care -- Methods KW - Postoperative Complications -- Prevention and Control KW - Tamoxifen -- Administration and Dosage KW - Venous Thromboembolism -- Prevention and Control KW - Algorithms KW - Antineoplastic Agents, Hormonal -- Adverse Effects KW - Antineoplastic Agents, Hormonal -- Therapeutic Use KW - Breast Neoplasms -- Surgery KW - Combined Modality Therapy KW - Female KW - Postoperative Complications -- Chemically Induced KW - Practice Guidelines KW - Tamoxifen -- Adverse Effects KW - Tamoxifen -- Therapeutic Use KW - Venous Thromboembolism -- Etiology SP - 313 EP - 316 JO - International Journal of Surgery JF - International Journal of Surgery JA - INT J SURG VL - 10 IS - 6 CY - New York, New York PB - Elsevier B.V. SN - 1743-9191 AD - Breast Surgery Unit, Cell Biology Proteomic Groups, Daisy Labs, Castle Hill Hospital, HYMS, University of Hull, UK. U2 - PMID: 22609485. DO - 10.1016/j.ijsu.2012.05.001 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104355708&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104416607 T1 - An Interactive System for Computer-Aided Diagnosis of Breast Masses. AU - Wang, Xingwei AU - Li, Lihua AU - Liu, Wei AU - Xu, Weidong AU - Lederman, Dror AU - Zheng, Bin Y1 - 2012/10// N1 - Accession Number: 104416607. Language: English. Entry Date: 20120928. Revision Date: 20150711. Publication Type: Journal Article; diagnostic images; equations & formulas; research; tables/charts. Journal Subset: Allied Health; Biomedical; Computer/Information Science; Double Blind Peer Reviewed; Peer Reviewed; USA. Special Interest: Oncologic Care. Grant Information: This work is supported in part by grants CA77850 to the University of Pittsburgh from the National Cancer Institute, National Institutes of Health, USA, and the National Distinguished Young Research Scientist Award (60788101) from National Natural Science Foundation of China.. NLM UID: 9100529. KW - Breast Neoplasms -- Diagnosis KW - Diagnosis, Computer Assisted KW - Mammography KW - Decision Support Techniques KW - Systems Design KW - Algorithms KW - Radiographic Image Enhancement -- Methods KW - Evaluation Research KW - ROC Curve KW - Confidence Intervals KW - P-Value KW - Human KW - Funding Source SP - 570 EP - 579 JO - Journal of Digital Imaging JF - Journal of Digital Imaging JA - J DIGIT IMAGING VL - 25 IS - 5 CY - , PB - Springer Science & Business Media B.V. AB - Although mammography is the only clinically accepted imaging modality for screening the general population to detect breast cancer, interpreting mammograms is difficult with lower sensitivity and specificity. To provide radiologists 'a visual aid' in interpreting mammograms, we developed and tested an interactive system for computer-aided detection and diagnosis (CAD) of mass-like cancers. Using this system, an observer can view CAD-cued mass regions depicted on one image and then query any suspicious regions (either cued or not cued by CAD). CAD scheme automatically segments the suspicious region or accepts manually defined region and computes a set of image features. Using content-based image retrieval (CBIR) algorithm, CAD searches for a set of reference images depicting 'abnormalities' similar to the queried region. Based on image retrieval results and a decision algorithm, a classification score is assigned to the queried region. In this study, a reference database with 1,800 malignant mass regions and 1,800 benign and CAD-generated false-positive regions was used. A modified CBIR algorithm with a new function of stretching the attributes in the multi-dimensional space and decision scheme was optimized using a genetic algorithm. Using a leave-one-out testing method to classify suspicious mass regions, we compared the classification performance using two CBIR algorithms with either equally weighted or optimally stretched attributes. Using the modified CBIR algorithm, the area under receiver operating characteristic curve was significantly increased from 0.865 ± 0.006 to 0.897 ± 0.005 ( p < 0.001). This study demonstrated the feasibility of developing an interactive CAD system with a large reference database and achieving improved performance. SN - 0897-1889 AD - Department of Radiology, University of Pittsburgh, 3362 Fifth Avenue Pittsburgh 15213 USA AD - College of Life Information Science and Instrument Engineering, Hangzhou Dianzi University, Hangzhou 310018 China U2 - PMID: 22234836. DO - 10.1007/s10278-012-9451-0 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104416607&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104370869 T1 - Decision support by telephone: Randomized controlled trial in a rural community setting. AU - Belkora J AU - Stupar L AU - O'Donnell S AU - Loucks A AU - Moore D AU - Jupiter C AU - Johnson N AU - Wilson L Y1 - 2012/10// N1 - Accession Number: 104370869. Language: English. Entry Date: 20130201. Revision Date: 20150711. Publication Type: Journal Article; clinical trial; research. Journal Subset: Core Nursing; Europe; Health Promotion/Education; Nursing; Peer Reviewed; UK & Ireland. NLM UID: 8406280. KW - Breast Neoplasms -- Psychosocial Factors KW - Decision Making KW - Referral and Consultation -- Economics KW - Support, Psychosocial KW - Telephone KW - Adult KW - Aged KW - Breast Neoplasms -- Diagnosis KW - Breast Neoplasms -- Economics KW - Health Services Research KW - Confidence Intervals KW - Cost Benefit Analysis KW - Female KW - Human KW - Interviews KW - Middle Age KW - Quality of Health Care KW - Questionnaires KW - Referral and Consultation -- Statistics and Numerical Data KW - Rural Health Services -- Administration KW - Rural Population KW - Self-Efficacy KW - Socioeconomic Factors KW - Clinical Trials SP - 134 EP - 142 JO - Patient Education & Counseling JF - Patient Education & Counseling JA - PATIENT EDUC COUNS VL - 89 IS - 1 PB - Elsevier B.V. AB - OBJECTIVE: Our community-based participatory research partnership previously evaluated Consultation Planning (CP), a question-listing intervention delivered in-person. We now report on effectiveness, cost, and value of delivering CP by telephone (Tele-CP). METHODS: Between 2007 and 2010, we randomly assigned rural women with a diagnosis of breast cancer to receive Tele-CP or In-Person CP. We compared ratings of decision self-efficacy (0 minimum to 4 maximum) with a pre-specified non-inferiority margin of 15%. We also explored psychosocial and economic outcomes. RESULTS: Tele-CP (n=35) recipients reported mean decision self-efficacy ratings of 3.53 versus 3.44 for in-person (n=32). Under intent-to-treat analysis, we rejected the null hypothesis of greater than 0.52 inferiority for Tele-CP (95% CI for difference: -0.44 to 0.13, p=0.006). The intervention costs averaged $48 for Tele-CP versus $78 in-person (95% CI for difference: -$63 to $2). Mean willingness-to-pay was $154 for Tele-CP and $144 for in-person (95% CI for difference: -$88 to $108). CONCLUSION: Tele-CP was non-inferior to In-Person CP, cost no more, and was equally valued by patients. PRACTICE IMPLICATIONS: Telephone delivery of Consultation Planning can achieve comparable quality, cost, and value as in-person. Organizations offering Consultation Planning or similar question-listing interventions should consider adopting telephone delivery. SN - 0738-3991 AD - University of California, San Francisco, USA. Electronic address: jeff.belkora@ucsf.edu. U2 - PMID: 22776761. DO - 10.1016/j.pec.2012.06.009 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104370869&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104420297 T1 - There is more to life than death. AU - Hartzband P AU - Groopman J Y1 - 2012/09/13/ N1 - Accession Number: 104420297. Language: English. Entry Date: 20121005. Revision Date: 20150711. Publication Type: Journal Article. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 0255562. KW - Decision Support Techniques KW - Early Detection of Cancer -- Psychosocial Factors KW - Quality of Life KW - Risk Assessment -- Methods KW - Adult KW - Breast Neoplasms -- Diagnosis KW - Breast Neoplasms -- Mortality KW - Death KW - False Positive Results KW - Female KW - Male KW - Mammography KW - Middle Age KW - Prostate-Specific Antigen -- Blood KW - Prostatic Neoplasms -- Diagnosis KW - Prostatic Neoplasms -- Mortality SP - 987 EP - 989 JO - New England Journal of Medicine JF - New England Journal of Medicine JA - N ENGL J MED VL - 367 IS - 11 CY - Waltham, Massachusetts PB - New England Journal of Medicine SN - 0028-4793 AD - Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA. U2 - PMID: 22970943. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104420297&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 108149008 T1 - Pairing up: shared decision making in cancer screening. AU - Gulian, Heather J Peterson Y1 - 2012/09//2012 Sep N1 - Accession Number: 108149008. Language: English. Entry Date: 20121005. Revision Date: 20150712. Publication Type: Journal Article; pictorial; review; tables/charts. Journal Subset: Nursing; USA. Special Interest: Advanced Nursing Practice; Oncologic Care. KW - Cancer Screening KW - Consumer Participation KW - Decision Making, Clinical KW - Decision Making, Patient KW - Neoplasms -- Prevention and Control KW - Practice Guidelines KW - American Cancer Society KW - Biopsy KW - Breast Examination KW - Breast Neoplasms -- Prevention and Control KW - Cancer Screening -- Adverse Effects KW - Cervical Smears KW - Cervix Neoplasms -- Prevention and Control KW - Colonoscopy KW - Colorectal Neoplasms -- Prevention and Control KW - Decision Support Techniques KW - Digital Rectal Examination KW - False Positive Results KW - Female KW - Health Resource Utilization KW - Male KW - Mammography KW - Occult Blood KW - Patient Education KW - Prostate-Specific Antigen -- Analysis KW - Prostatic Neoplasms -- Prevention and Control KW - United States Preventive Services Task Force SP - 19 EP - 23 JO - Advance for NPs & PAs JF - Advance for NPs & PAs JA - ADV NPS PAS VL - 3 IS - 9 CY - King of Prussia, Pa 19406-0956, Pennsylvania PB - Merion Publications SN - 2325-6699 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=108149008&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104498748 T1 - Impact of axillary ultrasound and core needle biopsy on the utility of intraoperative frozen section analysis and treatment decision making in women with invasive breast cancer. AU - Caretta-Weyer H AU - Sisney GA AU - Beckman C AU - Burnside ES AU - Salkowsi LR AU - Strigel RM AU - Wilke LG AU - Neuman HB AU - Caretta-Weyer, Holly AU - Sisney, Gale A AU - Beckman, Catherine AU - Burnside, Elizabeth S AU - Salkowsi, Lonie R AU - Strigel, Roberta M AU - Wilke, Lee G AU - Neuman, Heather B Y1 - 2012/09// N1 - Accession Number: 104498748. Language: English. Entry Date: 20121109. Revision Date: 20170405. Publication Type: journal article; research. Journal Subset: Biomedical; USA. Special Interest: Perioperative Care. NLM UID: 0370473. KW - Biopsy, Needle KW - Breast Neoplasms -- Pathology KW - Breast Neoplasms -- Therapy KW - Carcinoma, Ductal, Breast -- Pathology KW - Carcinoma, Ductal, Breast -- Therapy KW - Frozen Sections KW - Lymph Nodes -- Pathology KW - Lymph Nodes -- Ultrasonography KW - Lumpectomy KW - Sentinel Lymph Node Biopsy KW - Adult KW - Aged KW - Aged, 80 and Over KW - Axilla -- Ultrasonography KW - Breast Neoplasms -- Surgery KW - Breast Neoplasms -- Ultrasonography KW - Carcinoma, Ductal, Breast -- Surgery KW - Carcinoma, Ductal, Breast -- Ultrasonography KW - Female KW - Human KW - Intraoperative Period KW - Neoplasm Metastasis -- Ultrasonography KW - Middle Age KW - Prognosis KW - Neoplasm Staging KW - Predictive Value of Tests KW - Retrospective Design KW - Sensitivity and Specificity KW - Tumor Markers, Biological -- Analysis SP - 308 EP - 314 JO - American Journal of Surgery JF - American Journal of Surgery JA - AM J SURG VL - 204 IS - 3 CY - Philadelphia, Pennsylvania PB - Elsevier B.V. AB - Background: Our objective was to evaluate the impact of preoperative axillary ultrasound and core needle biopsy (CNB) on breast cancer treatment decision making. A secondary aim was to evaluate the impact on the utility of intraoperative sentinel lymph node (SLN) frozen section. Methods: A review of 84 patients with clinically negative axilla who underwent axillary ultrasound was performed. Sensitivity, specificity, and positive/negative predictive value for axillary ultrasound with CNB was calculated. Results: Thirty-one (37%) had suspicious nodes. Of 27 amenable to CNB, 12 (14%) were malignant, changing treatment plans. The sensitivity of ultrasound and CNB was 54% and specificity 100%; the positive and negative predictive values were 100% and 80%, respectively. In 41 patients with normal ultrasounds who underwent SLN frozen section, 10 (24%) were positive. Conclusions: Preoperative axillary ultrasound impacts treatment decision making in 14%. With a sensitivity of 54%, it is a useful adjunct to, but not replacement for, SLN biopsy. Frozen section remains of utility even after a negative axillary ultrasound. SN - 0002-9610 AD - Department of Surgery, Division of Surgical Oncology, University of Wisconsin, Madison, WI 53792-7375, USA AD - Department of Surgery, Division of Surgical Oncology, University of Wisconsin, Madison, WI 53792-7375, USA. U2 - PMID: 22483606. DO - 10.1016/j.amjsurg.2011.10.016 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104498748&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104494515 T1 - Development of patients' decision aid for older women with stage I breast cancer considering radiotherapy after lumpectomy. AU - Wong J AU - D'Alimonte L AU - Angus J AU - Paszat L AU - Metcalfe K AU - Whelan T AU - Llewellyn-Thomas H AU - Warner E AU - Franssen E AU - Szumacher E Y1 - 2012/09// N1 - Accession Number: 104494515. Language: English. Entry Date: 20121109. Revision Date: 20150711. Publication Type: Journal Article; consumer/patient teaching materials; research. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Oncologic Care. NLM UID: 7603616. KW - Breast Neoplasms -- Radiotherapy KW - Decision Support Techniques KW - Pamphlets KW - Age Factors KW - Aged KW - Aged, 80 and Over KW - Breast Neoplasms KW - Breast Neoplasms -- Pathology KW - Breast Neoplasms -- Psychosocial Factors KW - Breast Neoplasms -- Surgery KW - Decision Making KW - Female KW - Human KW - Lumpectomy KW - Consumer Participation KW - Pilot Studies KW - Questionnaires KW - Radiotherapy, Adjuvant -- Adverse Effects KW - Radiotherapy, Adjuvant -- Methods KW - Radiotherapy, Adjuvant -- Psychosocial Factors KW - Proteins -- Analysis SP - 30 EP - 38 JO - International Journal of Radiation Oncology, Biology, Physics JF - International Journal of Radiation Oncology, Biology, Physics JA - INT J RADIAT ONCOL BIOL PHYS VL - 84 IS - 1 PB - Pergamon Press - An Imprint of Elsevier Science SN - 0360-3016 AD - Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario. U2 - PMID: 22331002. DO - 10.1016/j.ijrobp.2011.11.028 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104494515&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 108098338 T1 - Adjuvant Therapy of Breast Cancer in Women 70 Years of Age and Older: Tough Decisions, High Stakes. AU - Jones, Ellen L. AU - Leak, Ashley AU - Muss, Hyman B. Y1 - 2012/09// N1 - Accession Number: 108098338. Language: English. Entry Date: 20121001. Revision Date: 20150712. Publication Type: Journal Article; algorithm; tables/charts. Commentary: Van Londen Gijsberta J., Livesey Kristen M., Lembersky Barry C. Breast Cancer: Never Too Young for a Functional Assessment? (ONCOLOGY (08909091)) Sep2012; 26 (9): 811-812; Mccormick Beryl. More on Facing the Reality of Our Aging Population With Breast Cancer. (ONCOLOGY (08909091)) Sep2012; 26 (9): 804-806. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Gerontologic Care; Oncologic Care. NLM UID: 8712059. KW - Breast Neoplasms -- Therapy -- In Old Age KW - Age Specific Care KW - Decision Making, Clinical KW - Survival -- In Old Age KW - Comorbidity KW - Aged KW - Information Resources KW - Geriatric Assessment KW - Receptors, Cell Surface KW - Frail Elderly KW - Radiotherapy, Adjuvant -- In Old Age KW - Decision Trees KW - Antineoplastic Agents, Hormonal -- In Old Age KW - Chemotherapy, Adjuvant -- In Old Age KW - Tamoxifen -- Therapeutic Use -- In Old Age SP - 793 EP - 801 JO - Oncology (08909091) JF - Oncology (08909091) JA - ONCOLOGY (08909091) VL - 26 IS - 9 CY - Norwalk, Connecticut PB - UBM Medica SN - 0890-9091 AD - University of North Carolina at Chapel Hill AD - University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, Chapel Hill, NC U2 - PMID: 23061331. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=108098338&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104486207 T1 - Development of a shared decision making coding system for analysis of patient-healthcare provider encounters. AU - Clayman ML AU - Makoul G AU - Harper MM AU - Koby DG AU - Williams AR AU - Clayman, Marla L AU - Makoul, Gregory AU - Harper, Maya M AU - Koby, Danielle G AU - Williams, Adam R Y1 - 2012/09// N1 - Accession Number: 104486207. Language: English. Entry Date: 20121109. Revision Date: 20161117. Publication Type: journal article; research. Journal Subset: Core Nursing; Europe; Health Promotion/Education; Nursing; Peer Reviewed; UK & Ireland. Special Interest: Evidence-Based Practice. Grant Information: R03 CA124202/CA/NCI NIH HHS/United States. NLM UID: 8406280. KW - Breast Neoplasms -- Psychosocial Factors KW - Coding -- Methods KW - Decision Making KW - Consumer Participation -- Psychosocial Factors KW - Physician-Patient Relations KW - Aged KW - Communication KW - Decision Support Techniques KW - Medical Practice, Evidence-Based KW - Female KW - Human KW - Middle Age KW - Patient Centered Care KW - Questionnaires KW - Reproducibility of Results KW - Self-Efficacy KW - Videorecording SP - 367 EP - 372 JO - Patient Education & Counseling JF - Patient Education & Counseling JA - PATIENT EDUC COUNS VL - 88 IS - 3 PB - Elsevier B.V. AB - Objectives: To describe the development and refinement of a scheme, detail of essential elements and participants in shared decision making (DEEP-SDM), for coding shared decision making (SDM) while reporting on the characteristics of decisions in a sample of patients with metastatic breast cancer.Methods: The evidence-based patient choice instrument was modified to reflect Makoul and Clayman's integrative model of SDM. Coding was conducted on video recordings of 20 women at the first visit with their medical oncologists after suspicion of disease progression. Noldus Observer XT v.8, a video coding software platform, was used for coding.Results: The sample contained 80 decisions (range: 1-11), divided into 150 decision making segments. Most decisions were physician-led, although patients and physicians initiated similar numbers of decision-making conversations.Conclusion: DEEP-SDM facilitates content analysis of encounters between women with metastatic breast cancer and their medical oncologists. Despite the fractured nature of decision making, it is possible to identify decision points and to code each of the essential elements of shared decision making. Further work should include application of DEEP-SDM to non-cancer encounters.Practice Implications: A better understanding of how decisions unfold in the medical encounter can help inform the relationship of SDM to patient-reported outcomes. SN - 0738-3991 AD - Division of General Internal Medicine, Northwestern University, Chicago, IL, USA AD - Division of General Internal Medicine, Northwestern University, Chicago, IL, USA. U2 - PMID: 22784391. DO - 10.1016/j.pec.2012.06.011 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104486207&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104489872 T1 - Nomogram to predict the benefit of radiation for older patients with breast cancer treated with conservative surgery. AU - Albert, Jeffrey M AU - Liu, Diane D AU - Shen, Yu AU - Pan, I-Wen AU - Shih, Ya-Chen Tina AU - Hoffman, Karen E AU - Buchholz, Thomas A AU - Giordano, Sharon H AU - Smith, Benjamin D Y1 - 2012/08/10/ N1 - Accession Number: 104489872. Language: English. Entry Date: 20121019. Revision Date: 20161117. Publication Type: journal article; research. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Oncologic Care. Grant Information: CA16672/CA/NCI NIH HHS/United States. NLM UID: 8309333. KW - Breast Neoplasms -- Radiotherapy KW - Models, Statistical KW - Aged KW - Breast Neoplasms -- Surgery KW - Female KW - Human KW - Lumpectomy KW - Registries, Disease KW - Scales SP - 2837 EP - 2843 JO - Journal of Clinical Oncology JF - Journal of Clinical Oncology JA - J CLIN ONCOL VL - 30 IS - 23 CY - Alexandria, Virginia PB - American Society of Clinical Oncology AB - Purpose: The role of radiation therapy (RT) after conservative surgery (CS) remains controversial for older patients with breast cancer. Guidelines based on recent clinical trials have suggested that RT may be omitted in selected patients with favorable disease. However, it is not known whether this recommendation should extend to other older women. Accordingly, we developed a nomogram to predict the likelihood of long-term breast preservation with and without RT.Methods: We used Surveillance, Epidemiology, and End Results-Medicare data to identify 16,092 women age 66 to 79 years treated with CS between 1992 and 2002, using claims to identify receipt of RT and subsequent mastectomy. Time to mastectomy was estimated using the Kaplan-Meier method. Cox proportional hazards models determined the effect of covariates on mastectomy-free survival (MFS). A nomogram was developed to predict 5- and 10-year MFS, given associated risk factors, and bootstrap validation was performed.Results: With a median follow-up of 7.2 years, the overall 5- and 10-year MFS rates were 98.1% (95% CI, 97.8% to 98.3%) and 95.4% (95% CI, 94.9% to 95.8%), respectively. In multivariate analysis, age, race, tumor size, estrogen receptor status, and receipt of RT were predictive of time to mastectomy and were incorporated into the nomogram. Nodal status was also included given a significant interaction with RT. The resulting nomogram demonstrated good accuracy in predicting MFS, with a bootstrap-corrected concordance index of 0.66.Conclusion: This clinically useful tool predicts 5- and 10-year MFS among older women with early breast cancer using readily available clinicopathologic factors and can aid individualized clinical decision making by estimating predicted benefit from RT. SN - 0732-183X AD - Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1202, Houston, TX 77030; bsmith3@mdanderson.org. U2 - PMID: 22734034. DO - 10.1200/JCO.2011.41.0076 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104489872&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104353613 T1 - Pharmacogenetics of anti-estrogen treatment of breast cancer. AU - Del Re M AU - Michelucci A AU - Simi P AU - Danesi R Y1 - 2012/08// N1 - Accession Number: 104353613. Language: English. Entry Date: 20130705. Revision Date: 20150711. Publication Type: Journal Article. Journal Subset: Biomedical; Double Blind Peer Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care. NLM UID: 7502030. KW - Breast Neoplasms KW - Breast Neoplasms -- Drug Therapy KW - Estrogen Antagonists -- Therapeutic Use KW - Pharmacogenetics KW - Tamoxifen -- Pharmacodynamics KW - Aromatase KW - Aromatase Inhibitors -- Therapeutic Use KW - Aromatase -- Metabolism KW - Female KW - Genetics KW - Oxidoreductases KW - Oxidoreductases -- Metabolism KW - Polymorphism, Genetic KW - Proteins KW - Receptors, Cell Surface KW - Tamoxifen -- Analogs and Derivatives KW - Tamoxifen -- Metabolism KW - Tamoxifen -- Therapeutic Use KW - Transferases KW - Transferases -- Metabolism SP - 442 EP - 450 JO - Cancer Treatment Reviews JF - Cancer Treatment Reviews JA - CANCER TREAT REV VL - 38 IS - 5 CY - Philadelphia, Pennsylvania PB - W B Saunders AB - A major effort is underway to select genetic polymorphisms potentially relevant to the clinical efficacy and safety of endocrine treatment of breast cancer. Genetic factors of the host that affect the metabolism of tamoxifen, a widely used drug for the adjuvant treatment of breast cancer, have received particular attention. Cytochrome P450 isoform 2D6 (CYP2D6) is a key step in the metabolism of tamoxifen to its active moiety endoxifen. Women with functionally deficient genetic variants of CYP2D6 who are given drugs that inhibit CYP2D6 are exposed to low endoxifen plasma levels and may enjoy reduced benefits from tamoxifen treatment. Therefore, CYP2D6 status may be an important predictor of the benefits of tamoxifen to an individual; unfortunately, the data are not uniformly concordant, and definitive evidence that would suggest the routine analysis of CYP2D6 before commencing tamoxifen treatment is not yet available. Recent research has focused on the role UDP-glucuronosyltransferases, a family of metabolizing enzymes that play an important role in the metabolic clearance of tamoxifen and of the aromatase inhibitors as well, and how interindividual differences in these enzymes may play a role in the clinical outcome upon administration of anti-estrogen treatment. In conclusion, whether a pharmacogenetic profile should be obtained prior to initiating tamoxifen therapy is currently a matter of debate, although summing up all the scientific evidence available on this issue it appears that the genetic screening would be an useful support for clinical decision making in selected patients. SN - 0305-7372 AD - Division of Pharmacology, Department of Internal Medicine, University of Pisa, Italy. U2 - PMID: 21917382. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104353613&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104420618 T1 - Increasing readiness to decide and strengthening behavioral intentions: evaluating the impact of a web-based patient decision aid for breast cancer treatment options (BresDex: www.bresdex.com). AU - Sivell S AU - Edwards A AU - Manstead AS AU - Reed MW AU - Caldon L AU - Collins K AU - Clements A AU - Elwyn G AU - Sivell, Stephanie AU - Edwards, Adrian AU - Manstead, Antony S R AU - Reed, Malcolm W R AU - Caldon, Lisa AU - Collins, Karen AU - Clements, Alison AU - Elwyn, Glyn Y1 - 2012/08// N1 - Accession Number: 104420618. Corporate Author: BresDex Group. Language: English. Entry Date: 20121109. Revision Date: 20171115. Publication Type: journal article; research. Journal Subset: Core Nursing; Europe; Health Promotion/Education; Nursing; Peer Reviewed; UK & Ireland. Grant Information: MCCC-FCO-11-C//Marie Curie/United Kingdom. NLM UID: 8406280. KW - Breast Neoplasms -- Psychosocial Factors KW - Decision Making KW - Decision Support Techniques KW - Attitude to Health KW - Intention KW - Internet KW - Patient Education -- Methods KW - Adult KW - Aged KW - Aged, 80 and Over KW - Breast Neoplasms -- Surgery KW - Prospective Studies KW - Female KW - Health Behavior KW - Human KW - Mastectomy KW - Middle Age KW - Consumer Participation -- Trends KW - Patient Satisfaction KW - Questionnaires SP - 209 EP - 217 JO - Patient Education & Counseling JF - Patient Education & Counseling JA - PATIENT EDUC COUNS VL - 88 IS - 2 PB - Elsevier B.V. AB - Objectives: To undertake a quantitative evaluation of a theory-based, interactive online decision aid (BresDex) to support women choosing surgery for early breast cancer (Stage I and II), based on observations of its use in practice.Methods: Observational cohort study. Website log-files collected data on the use of BresDex. Online questionnaires assessed knowledge about breast cancer and treatment options, degree to which women were deliberating about their options, and surgery intentions, pre- and post-BresDex.Results: Readiness to make a decision significantly increased after using BresDex (p<.001), although there was no significant improvement in knowledge. Participants that were 'less ready' to make a decision before using BresDex, spent a longer time using BresDex (p<.05). Significant associations between surgery intentions and choices were observed (p<.001), with the majority of participants going on to have BCS. Greater length of time spent on BresDex was associated with stronger intentions to have BCS (p<.05).Conclusion: The use of BresDex appears to facilitate readiness to make a decision for surgery, helping to strengthen surgery intentions.Practice Implications: BresDex may prove a useful adjunct to the support provided by the clinical team for women facing surgery for early breast cancer. SN - 0738-3991 AD - Marie Curie Palliative Care Research Centre, Wales Cancer Trials Unit, School of Medicine, Cardiff University, Cardiff, UK AD - Marie Curie Palliative Care Research Centre, Wales Cancer Trials Unit, School of Medicine, Cardiff University, Cardiff, UK. sivells2@cardiff.ac.uk U2 - PMID: 22541508. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104420618&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104356224 T1 - Using the Skindex-16 and Common Terminology Criteria for Adverse Events to assess rash symptoms: results of a pooled-analysis (N0993). AU - Atherton PJ AU - Burger KN AU - Loprinzi CL AU - Neben Wittich MA AU - Miller RC AU - Jatoi A AU - Sloan JA AU - Atherton, Pamela J AU - Burger, Kelli N AU - Loprinzi, Charles L AU - Neben Wittich, Michelle A AU - Miller, Robert C AU - Jatoi, Aminah AU - Sloan, Jeff A Y1 - 2012/08// N1 - Accession Number: 104356224. Language: English. Entry Date: 20130111. Revision Date: 20161125. Publication Type: journal article; research. Journal Subset: Biomedical; Continental Europe; Double Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed. Special Interest: Oncologic Care. Grant Information: U10 CA037404/CA/NCI NIH HHS/United States. NLM UID: 9302957. KW - Antineoplastic Agents -- Adverse Effects KW - Exanthema -- Chemically Induced KW - Exanthema -- Classification KW - Neoplasms -- Complications KW - Neoplasms -- Therapy KW - Radiodermatitis -- Classification KW - Severity of Illness Indices KW - Nomenclature KW - Algorithms KW - Antiinflammatory Agents -- Therapeutic Use KW - Antibodies, Monoclonal -- Adverse Effects KW - Breast Neoplasms -- Radiotherapy KW - Female KW - Human KW - Male KW - Middle Age KW - Steroids -- Therapeutic Use KW - Enzyme Inhibitors -- Adverse Effects KW - Enzyme Inhibitors -- Therapeutic Use KW - Questionnaires KW - Heterocyclic Compounds -- Adverse Effects KW - Radiodermatitis -- Prevention and Control KW - Clinical Trials KW - Sunscreening Agents -- Therapeutic Use KW - Tetracycline -- Therapeutic Use SP - 1729 EP - 1735 JO - Supportive Care in Cancer JF - Supportive Care in Cancer JA - SUPPORT CARE CANCER VL - 20 IS - 8 CY - , PB - Springer Science & Business Media B.V. AB - Background: Historically, skin toxicity has been assessed in prospective clinical trials using the clinician-reported National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE). The patient-reported Skindex-16 measures symptoms and perceptions of toxicity. This study was designed to compare information provided by these two measures.Methods: Data were compiled from three placebo-controlled North Central Cancer Treatment Group studies (N06C4, N03CB, N05C4) having rash prevention as the primary objective. All used the Skindex-16 and CTCAE at baseline, weekly during treatment and during a minimum 2-week follow-up period. Statistical procedures, including Pearson correlations, were utilized to determine relationships between adverse event (AE) grades and Skindex-16 scores.Results: Four hundred and twelve individual patients provided data (median age, 61; 134 male). Patients' Skindex-16 score results show a 0.9 overall mean (range 0-6 with 6 being worse symptoms), a 0.4 baseline mean (range, 0-4.3) and a 1.3 end-of-treatment mean (range, 0-5.9). Ninety-three, 142 and 177 patients experienced a grade 0, 1 and 2+ CTCAE skin toxicity, respectively. Baseline Skindex-16 scores had relatively low correlation with CTCAE grades. The correlation of rash grade with Skindex-16 scores ranged from r = 0.49 with the function subscale to r = 0.62 with the symptom subscale. The highest correlations of the maximum grade of any dermatological AE with the Skindex-16 were r = 0.48 for the total score and r = 0.55 for the symptom subscale.Conclusions: The data reported support the decision to include both measures in a clinical trial to assess the patient experience, as each measure may specifically target varying symptoms and intensities. SN - 0941-4355 AD - Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA AD - Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA, atherton@mayo.edu. U2 - PMID: 21922203. DO - 10.1007/s00520-011-1266-x UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104356224&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104472280 T1 - Validation of the louisville breast sentinel node prediction models and a proposed modification to guide management of the node positive axilla. AU - Lannin DR AU - Killelea B AU - Horowitz N AU - Chagpar AB Y1 - 2012/07// N1 - Accession Number: 104472280. Language: English. Entry Date: 20120914. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; USA. Special Interest: Perioperative Care. NLM UID: 0370522. KW - Breast Neoplasms -- Pathology KW - Decision Support Techniques KW - Sentinel Lymph Node Biopsy -- Methods KW - Algorithms KW - Axilla KW - Breast Neoplasms -- Surgery KW - Female KW - Human KW - Lymph Node Excision KW - Neoplasm Metastasis KW - Mastectomy KW - Middle Age KW - Models, Biological KW - Patient Selection KW - Retrospective Design SP - 761 EP - 765 JO - American Surgeon JF - American Surgeon JA - AM SURG VL - 78 IS - 7 CY - Westwood, Kansas PB - Southeastern Surgical Congress SN - 0003-1348 AD - Department of Surgery and Yale Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut, USA. U2 - PMID: 22748534. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104472280&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104451773 T1 - Elder women’s decision-making in breast cancer care: An Israeli study. AU - Kadmon, Ilana AU - Pierce, Penny AU - Antonakos, Cathy L. Y1 - 2012/07// N1 - Accession Number: 104451773. Language: English. Entry Date: 20120706. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Core Nursing; Europe; Nursing; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care. Instrumentation: Michiigan Assessment of Decision Style (MADS)(Pierce). Grant Information: HWZOA Research Fund for Women Health.. NLM UID: 100885136. KW - Decision Making, Patient -- In Old Age -- Israel KW - Cancer Patients -- In Old Age -- Israel KW - Breast Neoplasms KW - Israel KW - Aged KW - Human KW - Female KW - Questionnaires KW - Descriptive Research KW - Descriptive Statistics KW - Information Seeking Behavior KW - Decision Making, Patient -- Evaluation KW - Decision Making, Patient -- Methods KW - Cross Sectional Studies KW - Age Factors KW - Convenience Sample KW - Summated Rating Scaling KW - Coefficient Alpha KW - Pearson's Correlation Coefficient KW - One-Way Analysis of Variance KW - Instrument Validation KW - Scales KW - Funding Source SP - 233 EP - 237 JO - European Journal of Oncology Nursing JF - European Journal of Oncology Nursing JA - EUR J ONCOL NURS VL - 16 IS - 3 PB - Churchill Livingstone, Inc. AB - Abstract: Purpose: Much research has examined women’s decision-making behaviour in breast cancer care. Patient age has shaped preferences, values, decision style and participation in treatment decisions. The aim of this study was to test the validity of the Michigan Assessment of Decision Style (MADS) () in an older cohort and provide information on decision styles to identify areas of tailored decision support necessary for Israeli women. Methods: This study examined the decision-making styles of older Israeli women receiving routine mammography screening. Fifty two women over 65 years of age, attending a routine mammography screening, were administered a questionnaire containing demographic information and the MADS to determine hypothetical treatment decision-making. The MADS is a 16-item questionnaire assessing decision-making behaviour by characterizing four factors: avoiding, deferring, information-seeking and deliberation. Results: Age, family history of breast cancer, and having a current mammography were not significantly associated with any of the four MADS factors. Deliberation and Deferring had the highest mean scores, followed closely by Information-Seeking and Avoidance. Correlations among the factors indicate a significant, positive correlation between Deliberation and Information-Seeking and a significant negative correlation between Deliberation and Deferring, consistent with previous studies. Conclusions: These findings indicate that older Israeli women’s decision style is characterized by information seeking and deliberation reflecting a disposition towards engagement. The findings contribute to clinicians’ understanding of women’s preferences by countering the traditionally accepted stereotype that older women will employ a passive role when faced with an important health care decision. SN - 1462-3889 AD - The Henrietta Szold Hadassah-Hebrew University School of Nursing, Hadassah Medical Organization, POB 12000, Kiryat Hadassah, Jerusalem 91120, Israel AD - University of Michigan, School of Nursing, Ann Arbor, MI, USA AD - University of Michigan, Ann Arbor, MI, USA U2 - PMID: 21764372. DO - 10.1016/j.ejon.2011.06.005 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104451773&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104471133 T1 - Surgical Treatment Differences Among Latina and African American Breast Cancer Survivors. AU - Campesino, Maureen AU - Koithan, Mary AU - Ruiz, Ester AU - Glover, Johanna Uriri AU - Juarez, Gloria AU - Choi, Myunghan AU - Krouse, Robert S. Y1 - 2012/07// N1 - Accession Number: 104471133. Language: English. Entry Date: 20120807. Revision Date: 20150819. Publication Type: Journal Article; research; tables/charts. Journal Subset: Core Nursing; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Nursing; Peer Reviewed; USA. Special Interest: Oncologic Care. Grant Information: This research was supported by a grant (5R03CA124752-02) from the National Cancer Institute/National Institutes of Health.. NLM UID: 7809033. KW - Cancer Survivors KW - Breast Neoplasms KW - Hispanics KW - Blacks KW - Human KW - Multimethod Studies KW - Female KW - Interviews KW - Content Analysis KW - Breast Neoplasms -- Surgery KW - Mastectomy KW - Coding KW - Data Analysis Software KW - Descriptive Statistics KW - T-Tests KW - Chi Square Test KW - Insurance, Health KW - Funding Source SP - E324 EP - 31 JO - Oncology Nursing Forum JF - Oncology Nursing Forum JA - ONCOL NURS FORUM VL - 39 IS - 4 CY - Pittsburgh, Pennsylvania PB - Oncology Nursing Society AB - Purpose/Objectives: To describe breast cancer treatment choices from the perspectives of Latina and African American breast cancer survivors.Design: An interdisciplinary team conducted a mixed-methodsstudy of women treated for stages I-IV breast cancer.Setting: Participants' homes in metropolitan areas.Sample: 39 participants in three groups: monolingual Spanish-speaking Latinas (n = 15), English-speaking Latinas (n = 15), and African American women (n = 9).Methods: Individual participant interviews were conducted by racially and linguistically matched nurse researchers, and sociodemographic data were collected. Content and matrix analysis methods were used.Main Research Variables: Perceptions of breast cancer care.Findings: High rates of mastectomy were noted for early-stage treatment (stage I or II). Among the participants diagnosed with early-stage breast cancer, the majority of English-speaking Latinas (n = 9) and African American women (n = 4) received a mastectomy. However, the majority of the Spanish-speaking Latina group (n = 5) received breast-conserving surgery. Four factors influenced the choice of mastectomy over lumpectomy across the three groups: clinical indicators, fear of recurrence, avoidance of adjuvant side effects, and perceived favorable survival outcomes. Spanish-speaking Latinas were more likely to rely on physician treatment recommendations, and the other two groups used a shared decision-making style.Conclusions: Additional study is needed to understand how women select and integrate treatment information with the recommendations they receive from healthcare providers. Among the Spanish-speaking Latina group, limited English proficiency, the use of translators in explaining treatment options, and a lack of available educational materials in Spanish are factors that influenced reliance on physician recommendations.Implications for Nursing: Oncology nurses were notably absent in supporting the women's treatment decision making. Advanced practice oncology nurses, coupled with language-appropriate educational resources, may provide essential guidance in clarifying surgical treatment choices for breast cancer among culturally and linguistically diverse populations. SN - 0190-535X AD - College of Nursing, University of Arizona, Tucson, AZ AD - Psychologist in Private Practice, Tempe, AZ AD - College of Nursing and Health Innovation, Arizona State University in Phoenix AD - City of Hope Cancer Center, Duarte, CA AD - College of Nursing and Health Innovation, Arizona State University AD - Southern Arizona Veteran's Affairs Health Care System, University of Arizona in Tucson U2 - PMID: 22750902. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104471133&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104454240 T1 - The role of the breast cancer surgeon in personalized cancer care: clinical utility of the 21-gene assay. AU - Laronga C AU - Harness JK AU - Dixon M AU - Borgen PI Y1 - 2012/06// N1 - Accession Number: 104454240. Language: English. Entry Date: 20120810. Revision Date: 20150711. Publication Type: Journal Article. Journal Subset: Biomedical; USA. Special Interest: Perioperative Care. NLM UID: 0370473. KW - Breast Neoplasms -- Surgery KW - Genetic Screening -- Methods KW - Individualized Medicine KW - Oncology KW - Physician's Role KW - Specialties, Surgical KW - Breast Neoplasms KW - Combined Modality Therapy KW - Decision Support Techniques KW - Female KW - Genetic Markers KW - Prognosis KW - Tumor Markers, Biological SP - 751 EP - 758 JO - American Journal of Surgery JF - American Journal of Surgery JA - AM J SURG VL - 203 IS - 6 CY - Philadelphia, Pennsylvania PB - Elsevier B.V. SN - 0002-9610 AD - H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA. U2 - PMID: 22516676. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104454240&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104453565 T1 - New fertility resource for young women with breast cancer. Y1 - 2012/06// N1 - Accession Number: 104453565. Language: English. Entry Date: 20120601. Revision Date: 20150711. Publication Type: Journal Article; pictorial. Journal Subset: Australia & New Zealand; Core Nursing; Nursing. Special Interest: Oncologic Care; Women's Health. NLM UID: 9317904. KW - Breast Neoplasms -- Complications KW - Chemotherapy, Cancer -- Adverse Effects KW - Reproductive Health -- Psychosocial Factors KW - Infertility -- Risk Factors KW - Patient Education KW - Young Adult KW - Fertilization in Vitro KW - Oocyte Donation KW - Decision Support Techniques KW - Nursing Role SP - 36 EP - 37 JO - Australian Nursing Journal JF - Australian Nursing Journal JA - AUST NURS J VL - 19 IS - 11 CY - Melbourne, PB - Australian Nursing & Midwifery Federation SN - 1320-3185 U2 - PMID: 22812042. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104453565&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104459585 T1 - Incorporation of expert variability into breast cancer treatment recommendation in designing clinical protocol guided fuzzy rule system models. AU - Garibaldi JM AU - Zhou SM AU - Wang XY AU - John RI AU - Ellis IO AU - Garibaldi, Jonathan M AU - Zhou, Shang-Ming AU - Wang, Xiao-Ying AU - John, Robert I AU - Ellis, Ian O Y1 - 2012/06// N1 - Accession Number: 104459585. Language: English. Entry Date: 20121026. Revision Date: 20161125. Publication Type: journal article; research. Journal Subset: Biomedical; Computer/Information Science; Peer Reviewed; USA. Special Interest: Informatics. Grant Information: MC_G0900866//Medical Research Council/United Kingdom. NLM UID: 100970413. KW - Breast Neoplasms -- Drug Therapy KW - Protocols -- Standards KW - Models, Biological KW - Decision Support Systems, Clinical KW - Logic KW - Great Britain SP - 447 EP - 459 JO - Journal of Biomedical Informatics JF - Journal of Biomedical Informatics JA - J BIOMED INFORM VL - 45 IS - 3 CY - Burlington, Massachusetts PB - Academic Press Inc. AB - It has been often demonstrated that clinicians exhibit both inter-expert and intra-expert variability when making difficult decisions. In contrast, the vast majority of computerized models that aim to provide automated support for such decisions do not explicitly recognize or replicate this variability. Furthermore, the perfect consistency of computerized models is often presented as a de facto benefit. In this paper, we describe a novel approach to incorporate variability within a fuzzy inference system using non-stationary fuzzy sets in order to replicate human variability. We apply our approach to a decision problem concerning the recommendation of post-operative breast cancer treatment; specifically, whether or not to administer chemotherapy based on assessment of five clinical variables: NPI (the Nottingham Prognostic Index), estrogen receptor status, vascular invasion, age and lymph node status. In doing so, we explore whether such explicit modeling of variability provides any performance advantage over a more conventional fuzzy approach, when tested on a set of 1310 unselected cases collected over a fourteen year period at the Nottingham University Hospitals NHS Trust, UK. The experimental results show that the standard fuzzy inference system (that does not model variability) achieves overall agreement to clinical practice around 84.6% (95% CI: 84.1-84.9%), while the non-stationary fuzzy model can significantly increase performance to around 88.1% (95% CI: 88.0-88.2%), p<0.001. We conclude that non-stationary fuzzy models provide a valuable new approach that may be applied to clinical decision support systems in any application domain. SN - 1532-0464 AD - Intelligent Modelling and Analysis Research Group, School of Computer Science, University of Nottingham, Nottingham NG8 1BB, United Kingdom AD - Intelligent Modelling and Analysis Research Group, School of Computer Science, University of Nottingham, Nottingham NG8 1BB, United Kingdom. U2 - PMID: 22265814. DO - 10.1016/j.jbi.2011.12.007 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104459585&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104446416 T1 - Possible logistic and sociodemographyc factors on breast cancer screening in Turkey: lessons from a women’s health project in Mersin province. AU - Abali, Huseyin AU - Ata, Alper AU - Gokçe, Gozde AU - Gokçe, Huseyin Y1 - 2012/06// N1 - Accession Number: 104446416. Language: English. Entry Date: 20120803. Revision Date: 20171115. Publication Type: journal article; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Health Promotion/Education; Peer Reviewed; USA. Special Interest: Oncologic Care; Public Health; Women's Health. NLM UID: 8610343. KW - Breast Neoplasms -- Prevention and Control KW - Cancer Screening -- Education KW - Cancer Screening -- Utilization KW - Health Education KW - Women's Health KW - Adolescence KW - Adult KW - Aged KW - Aged, 80 and Over KW - Breast Examination KW - Chi Square Test KW - Community Health Services KW - Data Analysis Software KW - Descriptive Statistics KW - Educational Status KW - Employment Status KW - Female KW - Health Resource Utilization KW - Human KW - Mammography KW - Marital Status KW - Middle Age KW - Multiple Logistic Regression KW - T-Tests KW - Turkey SP - 347 EP - 352 JO - Journal of Cancer Education JF - Journal of Cancer Education JA - J CANCER EDUC VL - 27 IS - 2 CY - , PB - Springer Science & Business Media B.V. AB - Mortality from breast cancer is decreasing partly owing to early detection. In Mersin province in our country, local health authorities launched an education program on sexual diseases and breast cancer early detection for women over 15 years of age. After the educational session, clinical breast examination was offered by a nurse or physician, and if suspicious they were recommended to apply a specialist for further examination. Here, we report the results on those women with abnormal clinical breast examination. In this second project, socio-demographic variables were investigated such as educational level and place of living,parameters to measure the success of previous project, whether they followed the recommendation themselves, whether mammograms were reported in accordance with Breast Imaging Reporting and Data System (BIRADS). Of 3,793 women recruited, mean age was 42.2 years, 42.3%were younger than 40.0 years. Majority (88.5%) were married, graduate of primary school (60.6%), without a job(91.2%), and inhabiting in the province (38.7%). Of the population, 98.1% believe in the importance of screening in the treatment of breast cancer. According to 70.3%,monthly breast self-examination enables early detection, 33.5% believe that clinical breast examination detects cancer early, and 35.5% think that annual mammography can detect it early. Among 2,183 women 40 years of age or over, 41.5% had mammography at once before participating in the first project. Breast self-examination was being carried out by 56.6% on a monthly basis. After an abnormal breast examination, 86.4% applied to hospitals for specialist examination. Reasons for declining to seek for further examination among 410 women answering were as follows:42.0% did not accept, 27.0% did not know it was important, 16.6% because of economical reasons, and 5.0% were too shy to be examined. Being older, being married, being the graduate of primary and secondary school, residing in rural areas, having a mammogram positively affected the decision in univariate analyses (p<0.05). All but educational level (p=0.059) remained significant in multivariate analysis. Mammography was reported in accordance with BIRADS in only 45 (1.2%). Awareness of population on breast cancer early detection can be raised through education. Generally, women follow professional recommendation from professionals. Mammography reporting among radiologist in accordance with BIRADS is rare. Successful early detection of breast cancer may be obtained by public education together with improving detection methods. SN - 0885-8195 AD - Department of Internal Medicine Division of Medical Oncology, Mersin University School of Medicine, Mersin Turkey U2 - PMID: 21976034. DO - 10.1007/s13187-011-0270-7 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104446416&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 108121278 T1 - Reducing the risk of breast cancer: A personalized approach. AU - Ko MG AU - Files JA AU - Pruthi S AU - Ko, Marcia G AU - Files, Julia A AU - Pruthi, Sandhya Y1 - 2012/06// N1 - Accession Number: 108121278. Language: English. Entry Date: 20120831. Revision Date: 20170411. Publication Type: journal article. Journal Subset: Biomedical; USA. NLM UID: 7502590. KW - Breast Neoplasms -- Prevention and Control KW - Individualized Medicine KW - Antineoplastic Agents -- Therapeutic Use KW - Breast Neoplasms -- Etiology KW - Breast Neoplasms -- Radiography KW - Decision Support Techniques KW - Family Practice KW - Female KW - Mammography KW - Mastectomy KW - Practice Guidelines KW - Risk Assessment KW - Risk Factors KW - Behavior SP - 340 EP - 347 JO - Journal of Family Practice JF - Journal of Family Practice JA - J FAM PRACT VL - 61 IS - 6 CY - Parsippany, New Jersey PB - Frontline Medical Communications SN - 0094-3509 AD - Mayo Clinic, Scottsdale, AZ 85369, USA AD - Mayo Clinic, Scottsdale, Ariz, USA. U2 - PMID: 22670237. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=108121278&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104472484 T1 - BresDex: Helping Women Make Breast Cancer Surgery Choices. AU - Jones B Y1 - 2012/06// N1 - Accession Number: 104472484. Language: English. Entry Date: 20121123. Revision Date: 20150711. Publication Type: Journal Article. Journal Subset: Biomedical; USA. NLM UID: 101254059. KW - Breast Neoplasms -- Surgery KW - Decision Making KW - Mastectomy -- Psychosocial Factors KW - Lumpectomy -- Psychosocial Factors KW - Women's Health KW - Breast Neoplasms -- Psychosocial Factors KW - Decision Support Techniques KW - Female KW - Patient Satisfaction SP - 59 EP - 64 JO - Journal of Visual Communication in Medicine JF - Journal of Visual Communication in Medicine JA - J VIS COMMUN MED VL - 35 IS - 2 CY - Philadelphia, Pennsylvania PB - Taylor & Francis Ltd SN - 1745-3054 AD - Cardiff and Vale University Local Health Board , UK. U2 - PMID: 22747264. DO - 10.3109/17453054.2012.690132 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104472484&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104450477 T1 - Using visual displays to communicate risk of cancer to women from diverse race/ethnic backgrounds. AU - Wong ST AU - Pérez-Stable EJ AU - Kim SE AU - Gregorich SE AU - Sawaya GF AU - Walsh JM AU - Washington AE AU - Kaplan CP AU - Wong, Sabrina T AU - Pérez-Stable, Eliseo J AU - Kim, Sue E AU - Gregorich, Steven E AU - Sawaya, George F AU - Walsh, Judith M E AU - Washington, A Eugene AU - Kaplan, Celia P Y1 - 2012/06// N1 - Accession Number: 104450477. Language: English. Entry Date: 20121005. Revision Date: 20161117. Publication Type: journal article; research. Journal Subset: Core Nursing; Europe; Health Promotion/Education; Nursing; Peer Reviewed; UK & Ireland. Grant Information: 5P01 HS10856/HS/AHRQ HHS/United States. NLM UID: 8406280. KW - Audiovisuals KW - Breast Neoplasms -- Prevention and Control KW - Colonic Neoplasms -- Prevention and Control KW - Ethnic Groups -- Statistics and Numerical Data KW - Health Behavior KW - Attitude to Health KW - Cervix Neoplasms -- Prevention and Control KW - Aged KW - Aged, 80 and Over KW - Breast Neoplasms -- Ethnology KW - Colonic Neoplasms -- Ethnology KW - Ethnological Research KW - Cross Sectional Studies KW - Decision Support Techniques KW - Female KW - Human KW - Health Screening -- Statistics and Numerical Data KW - Middle Age KW - Patient Attitudes -- Ethnology KW - Relative Risk KW - Cervix Neoplasms -- Ethnology SP - 327 EP - 335 JO - Patient Education & Counseling JF - Patient Education & Counseling JA - PATIENT EDUC COUNS VL - 87 IS - 3 PB - Elsevier B.V. AB - Objective: This study evaluated how well women from diverse race/ethnic groups were able to take a quantitative cancer risk statistic verbally provided to them and report it in a visual format.Methods: Cross-sectional survey was administered in English, Spanish or Chinese, to women aged 50-80 (n=1160), recruited from primary care practices. The survey contained breast, colorectal or cervical cancer questions regarding screening and prevention. Women were told cancer-specific lifetime risk then shown a visual display of risk and asked to indicate the specific lifetime risk. Correct indication of risk was the main outcome.Results: Correct responses on icon arrays were 46% for breast, 55% for colon, and 44% for cervical; only 25% correctly responded to a magnifying glass graphic. Compared to Whites, African American and Latina women were significantly less likely to use the icon arrays correctly. Higher education and higher numeracy were associated with correct responses. Lower education was associated with lower numeracy.Conclusions: Race/ethnic differences were associated with women's ability to take a quantitative cancer risk statistic verbally provided to them and report it in a visual format.Practice Implications: Systematically considering the complexity of intersecting factors such as race/ethnicity, educational level, poverty, and numeracy in most health communications is needed. SN - 0738-3991 AD - Medical Effectiveness Research Center for Diverse Populations, UCSF, USA AD - Medical Effectiveness Research Center for Diverse Populations, UCSF, USA; University of British Columbia, School of Nursing and Centre for Health Services and Policy Research, Vancouver, Canada. U2 - PMID: 22244322. DO - 10.1016/j.pec.2011.11.014 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104450477&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104566297 T1 - Challenges in ductal carcinoma in situ risk communication and decision-making: report from an American Cancer Society and National Cancer Institute workshop. AU - Partridge AH AU - Elmore JG AU - Saslow D AU - McCaskill-Stevens W AU - Schnitt SJ AU - Partridge, Ann H AU - Elmore, Joann G AU - Saslow, Debbie AU - McCaskill-Stevens, Worta AU - Schnitt, Stuart J Y1 - 2012/05//May/Jun2012 N1 - Accession Number: 104566297. Language: English. Entry Date: 20120803. Revision Date: 20161119. Publication Type: journal article. Journal Subset: Biomedical; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Oncologic Care. Grant Information: UL1 TR000423/TR/NCATS NIH HHS/United States. NLM UID: 0370647. KW - Breast Neoplasms -- Diagnosis KW - Breast Neoplasms -- Psychosocial Factors KW - Carcinoma in Situ -- Diagnosis KW - Carcinoma in Situ -- Psychosocial Factors KW - Carcinoma, Ductal, Breast -- Diagnosis KW - Carcinoma, Ductal, Breast -- Psychosocial Factors KW - Communication KW - Decision Making KW - Physician-Patient Relations KW - American Cancer Society KW - Congresses and Conferences KW - Female KW - Health Screening KW - Quality of Life KW - Risk Factors KW - Nomenclature KW - United States SP - 203 EP - 210 JO - CA: A Cancer Journal for Clinicians JF - CA: A Cancer Journal for Clinicians JA - CA VL - 62 IS - 3 CY - Malden, Massachusetts PB - Wiley-Blackwell AB - In September 2010, the American Cancer Society and National Cancer Institute convened a conference to review current issues in ductal carcinoma in situ (DCIS) risk communication and decision-making and to identify directions for future research. Specific topics included patient and health care provider knowledge and attitudes about DCIS and its treatment, how to explain DCIS to patients given the heterogeneity of the disease, consideration of nomenclature changes, and the usefulness of decision tools/aids. This report describes the proceedings of the workshop in the context of the current literature and discusses future directions. Evidence suggests that there is a lack of clarity about the implications and risks of a diagnosis of DCIS among patients, providers, and researchers. Research is needed to understand better the biology and mechanisms of the progression of DCIS to invasive breast cancer and the factors that predict those subtypes of DCIS that do not progress, as well as efforts to improve the communication and informed decision-making surrounding DCIS. SN - 0007-9235 AD - Department of Medicine, Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA 02215, USA AD - Associate Professor, Department of Medicine, Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA. ann_partridge@dfci.harvard.edu. U2 - PMID: 22488610. DO - 10.3322/caac.21140 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104566297&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104548414 T1 - A population-based breast cancer screening programme: conducting a comprehensive survey to explore adherence determinants. AU - Freitas, C. AU - Tura, L.F.R. AU - Costa, N. AU - Duarte, J. Y1 - 2012/05// N1 - Accession Number: 104548414. Language: English. Entry Date: 20120417. Revision Date: 20150819. Publication Type: Journal Article; research. Journal Subset: Core Nursing; Europe; Nursing; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care. NLM UID: 9301979. KW - Breast Neoplasms -- Prevention and Control KW - Cancer Screening KW - Patient Compliance KW - Health Behavior KW - Portugal KW - Cross Sectional Studies KW - Convenience Sample KW - Interviews KW - Chi Square Test KW - Multivariate Analysis KW - Algorithms KW - Comparative Studies KW - Middle Age KW - Aged KW - Female KW - Human SP - 349 EP - 359 JO - European Journal of Cancer Care JF - European Journal of Cancer Care JA - EUR J CANCER CARE VL - 21 IS - 3 CY - Malden, Massachusetts PB - Wiley-Blackwell AB - FREITAS C., TURA L.F.R., COSTA N. & DUARTE J. (2012) European Journal of Cancer Care 21, 349-359 A population-based breast cancer screening programme: conducting a comprehensive survey to explore adherence determinants This research examines several important individual and environmental variables that can predict breast cancer screening practices among Portuguese women aged 45-69 years old, under a population-based programme. A cross-sectional study was conducted to a convenience sample with 805 women in Aveiro municipality. Survey interviews were applied to adherents and non-adherents in two different settings (health centre, home places). A combination of bivariate (chi-squared test) and multivariate analysis [decision tree by the chi-squared automatic interaction detection (CHAID) algorithm] was performed to determine differences between the groups and predict the variables. Findings showed that there is a significant association between almost all 29 indicators with adherence and non-adherence. Younger women (<50 years) with 'concordant' Behaviour Profile to the guidelines are those who adhere more in comparison with the other age groups. On the other hand, those with non-adherent behaviour need to have a 'good' attendance of healthcare providers for becoming adherents to the screening programme. Multiple strategies that combine enhancing primary health care access, individual behaviour and knowledge must be addressed to uptake adherence. In this way, the health teams must act in accordance with the guidelines, targeting more effective health education practices to achieve the goals of the breast cancer screening. SN - 0961-5423 AD - Department of Education, University of Aveiro, Aveiro, Portugal AD - History, Health and Society Laboratory at Medicine School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil AD - Department of Education of the University of Aveiro/UA, COORDINATOR, Laboratory of Quality Assessment in Education (LAQE) of the Research Centre 'Didactics and Technology in Professional Education' and DIRECTOR, Doctoral Programme in Didactics and Formation of UA, Aveiro AD - Health School of Viseu, Nursing Sciences Department, Center for Studies in Education, Health and Technology (CI&DETS), Polytechnic Institute of Viseu, Viseu, Portugal U2 - PMID: 22077789. DO - 10.1111/j.1365-2354.2011.01305.x UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104548414&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 108187890 T1 - Acupuncture for hot flashes: decision making by breast cancer survivors. AU - Mao JJ AU - Leed R AU - Bowman MA AU - Desai K AU - Bramble M AU - Armstrong K AU - Barg F Y1 - 2012/05//2012 May-Jun N1 - Accession Number: 108187890. Language: English. Entry Date: 20120928. Revision Date: 20150712. Publication Type: Journal Article; research. Commentary: Ingram C. Guest family physician commentaries. (J AM BOARD FAM MED) 2012 May-Jun; 25 (3): 274-274. Journal Subset: Biomedical; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 101256526. KW - Acupuncture -- Methods KW - Breast Neoplasms -- Complications KW - Decision Making KW - Hot Flashes -- Therapy KW - Survivors KW - Adult KW - Aged KW - Breast Neoplasms -- Pathology KW - Breast Neoplasms -- Psychosocial Factors KW - Decision Support Techniques KW - Female KW - Attitude to Health KW - Hot Flashes -- Etiology KW - Hot Flashes -- Psychosocial Factors KW - Human KW - Diagnosis, Psychosocial KW - Middle Age KW - Time Factors KW - Women's Health SP - 323 EP - 332 JO - Journal of the American Board of Family Medicine JF - Journal of the American Board of Family Medicine JA - J AM BOARD FAM MED VL - 25 IS - 3 CY - Lexington, Kentucky PB - American Board of Family Medicine AB - Purpose: Hot flashes (HFs) are a particularly common and distressing symptom among breast cancer survivors (BCSs). Given its low rate of side effects, acupuncture shows promise as a therapeutic approach for HFs, but little is known about BCS's decision making about the use of acupuncture. This study seeks to identify attitudes and beliefs about using acupuncture for HFs by BCSs. METHODS: Using the Theory of Planned Behavior (TPB) as a conceptual framework, we conducted semistructured interviews among women with stage I-III breast cancer who had finished primary treatment and were currently experiencing HFs. Interviews were taped, transcribed, and coded. We used a modified grounded theory approach to analyze the data. RESULTS: Twenty-five BCSs (13 whites/12 African American) participated in the study. Respondents stated that their intended use of acupuncture for HFs would be dependent on (1) expected therapeutic effects (eg, pain relief, energy); (2) practical concerns (eg, fear of needles, practitioner experience, time commitment); and (3) source of decision support/validation (eg, family members, physicians, self). Although constructs in the TPB accounted for many decision factors, respondents identified 2 major themes outside of the TPB: (1) viewing acupuncture as a natural alternative to medications, and (2) assessing the degree of HFs as bothersome enough in the context of other medical comorbidities to trigger the need for therapy. CONCLUSION: BCSs expressed varied expected therapeutic benefits, practical concerns, and decision support, emphasizing the 'natural appeal' and symptom appraisal as key determinants when using acupuncture for HFs. Incorporating these factors in counseling BCSs may promote patient-centered communication, leading to improved hot flash management and quality of life. SN - 1557-2625 AD - the Department of Family Medicine and Community Health; the Center for Clinical Epidemiology and Biostatistics; the Abramson Cancer Center; the Center for Public Health Initiatives; and the Department of Medicine; University of Pennsylvania School of Medicine, Philadelphia. U2 - PMID: 22570396. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=108187890&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104546914 T1 - Yield of selective magnetic resonance imaging in preoperative workup of newly diagnosed breast cancer patients planned for breast conserving surgery. AU - Menes TS AU - Zissman S AU - Golan O AU - Sperber F AU - Klausner J AU - Schneebaum S Y1 - 2012/04// N1 - Accession Number: 104546914. Language: English. Entry Date: 20120810. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; USA. Special Interest: Perioperative Care. NLM UID: 0370522. KW - Breast Neoplasms -- Diagnosis KW - Magnetic Resonance Imaging KW - Lumpectomy KW - Neoplasms, Ductal, Lobular, and Medullary -- Diagnosis KW - Preoperative Care KW - Adult KW - Aged KW - Aged, 80 and Over KW - Breast Neoplasms -- Surgery KW - Decision Support Techniques KW - Female KW - Human KW - Middle Age KW - Neoplasms, Ductal, Lobular, and Medullary -- Surgery KW - Retrospective Design KW - Treatment Outcomes SP - 451 EP - 455 JO - American Surgeon JF - American Surgeon JA - AM SURG VL - 78 IS - 4 CY - Westwood, Kansas PB - Southeastern Surgical Congress SN - 0003-1348 AD - Department of Surgery, Sourasky Medical Center, Tel Aviv, Israel. U2 - PMID: 22472404. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104546914&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104536566 T1 - Effect of tumor subtype on survival and the graded prognostic assessment for patients with breast cancer and brain metastases. AU - Sperduto PW AU - Kased N AU - Roberge D AU - Xu Z AU - Shanley R AU - Luo X AU - Sneed PK AU - Chao ST AU - Weil RJ AU - Suh J AU - Bhatt A AU - Jensen AW AU - Brown PD AU - Shih HA AU - Kirkpatrick J AU - Gaspar LE AU - Fiveash JB AU - Chiang V AU - Knisely JP AU - Sperduto CM Y1 - 2012/04// N1 - Accession Number: 104536566. Language: English. Entry Date: 20120525. Revision Date: 20161125. Publication Type: journal article; research. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Oncologic Care. Grant Information: P30 CA077598-10/CA/NCI NIH HHS/United States. NLM UID: 7603616. KW - Brain Neoplasms KW - Brain Neoplasms -- Mortality KW - Breast Neoplasms -- Mortality KW - Breast Neoplasms -- Pathology KW - Adult KW - Age Factors KW - Aged KW - Aged, 80 and Over KW - Brain Neoplasms -- Pathology KW - Breast Neoplasms -- Metabolism KW - Breast Neoplasms, Male -- Metabolism KW - Breast Neoplasms, Male -- Mortality KW - Breast Neoplasms, Male -- Pathology KW - Cox Proportional Hazards Model KW - Female KW - Human KW - Karnofsky Performance Status KW - Male KW - Middle Age KW - Multivariate Analysis KW - Prognosis KW - Prospective Studies KW - Proteins -- Metabolism KW - Receptors, Cell Surface -- Metabolism KW - Retrospective Design SP - 2111 EP - 2117 JO - International Journal of Radiation Oncology, Biology, Physics JF - International Journal of Radiation Oncology, Biology, Physics JA - INT J RADIAT ONCOL BIOL PHYS VL - 82 IS - 5 PB - Pergamon Press - An Imprint of Elsevier Science AB - Purpose: The diagnosis-specific Graded Prognostic Assessment (GPA) was published to clarify prognosis for patients with brain metastases. This study refines the existing Breast-GPA by analyzing a larger cohort and tumor subtype.Methods and Materials: A multi-institutional retrospective database of 400 breast cancer patients treated for newly diagnosed brain metastases was generated. Prognostic factors significant for survival were analyzed by multivariate Cox regression and recursive partitioning analysis (RPA). Factors were weighted by the magnitude of their regression coefficients to define the GPA index.Results: Significant prognostic factors by multivariate Cox regression and RPA were Karnofsky performance status (KPS), HER2, ER/PR status, and the interaction between ER/PR and HER2. RPA showed age was significant for patients with KPS 60 to 80. The median survival time (MST) overall was 13.8 months, and for GPA scores of 0 to 1.0, 1.5 to 2.0, 2.5 to 3.0, and 3.5 to 4.0 were 3.4 (n = 23), 7.7 (n = 104), 15.1 (n = 140), and 25.3 (n = 133) months, respectively (p < 0.0001). Among HER2-negative patients, being ER/PR positive improved MST from 6.4 to 9.7 months, whereas in HER2-positive patients, being ER/PR positive improved MST from 17.9 to 20.7 months. The log-rank statistic (predictive power) was 110 for the Breast-GPA vs. 55 for tumor subtype.Conclusions: The Breast-GPA documents wide variation in prognosis and shows clear separation between subgroups of patients with breast cancer and brain metastases. This tool will aid clinical decision making and stratification in clinical trials. These data confirm the effect of tumor subtype on survival and show the Breast-GPA offers significantly more predictive power than the tumor subtype alone. SN - 0360-3016 U2 - PMID: 21497451. DO - 10.1016/j.ijrobp.2011.02.027 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104536566&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104442966 T1 - Effectiveness and cost-effectiveness of sentinel lymph node biopsy compared with axillary node dissection in patients with early-stage breast cancer: a decision model analysis. AU - Verry H AU - Lord SJ AU - Martin A AU - Gill G AU - Lee CK AU - Howard K AU - Wetzig N AU - Simes J Y1 - 2012/03/13/ N1 - Accession Number: 104442966. Language: English. Entry Date: 20121207. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care. NLM UID: 0370635. KW - Breast Neoplasms -- Pathology KW - Decision Support Techniques KW - Lymph Node Excision -- Economics KW - Neoplasm Staging -- Methods KW - Sentinel Lymph Node Biopsy -- Economics KW - Axilla KW - Breast Neoplasms -- Diagnosis KW - Cost Benefit Analysis KW - Female KW - Human KW - Neoplasm Metastasis KW - Probability KW - Clinical Trials KW - Sensitivity and Specificity SP - 1045 EP - 1052 JO - British Journal of Cancer JF - British Journal of Cancer JA - BR J CANCER VL - 106 IS - 6 CY - London, PB - Nature Publishing Group SN - 0007-0920 AD - NHMRC Clinical Trials Centre, University of Sydney, Locked Bag 77, Camperdown, New South Wales 2050, Australia. hannah.verry@ctc.usyd.edu.au U2 - PMID: 22415293. DO - 10.1038/bjc.2012.62 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104442966&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104442967 T1 - Making hard choices easier: a prospective, multicentre study to assess the efficacy of a fertility-related decision aid in young women with early-stage breast cancer. AU - Peate M AU - Meiser B AU - Cheah BC AU - Saunders C AU - Butow P AU - Thewes B AU - Hart R AU - Phillips KA AU - Hickey M AU - Friedlander M Y1 - 2012/03/13/ N1 - Accession Number: 104442967. Language: English. Entry Date: 20121207. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care. NLM UID: 0370635. KW - Breast Neoplasms -- Pathology KW - Decision Support Techniques KW - Reproduction Techniques KW - Adult KW - Anxiety KW - Breast Neoplasms -- Psychosocial Factors KW - Conflict (Psychology) KW - Decision Making KW - Depression KW - Emotions KW - Female KW - Human KW - Neoplasm Staging KW - Patient Education KW - Patient Satisfaction KW - Prospective Studies KW - Questionnaires KW - Referral and Consultation SP - 1053 EP - 1061 JO - British Journal of Cancer JF - British Journal of Cancer JA - BR J CANCER VL - 106 IS - 6 CY - London, PB - Nature Publishing Group SN - 0007-0920 AD - Prince of Wales Clinical School, University of NSW, Randwick, New South Wales, Australia. michelle.peate@sydney.edu.au U2 - PMID: 22415294. DO - 10.1038/bjc.2012.61 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104442967&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104537938 T1 - Working Toward a Decision: The Development and First Impressions of a Decision Aid for Older Women with Early-stage Breast Cancer. AU - D’Alimonte, Laura AU - Angus, Jan AU - Wong, Jennifer AU - Paszat, Larry AU - Soren, Barbara AU - Szumacher, Ewa Y1 - 2012/03// N1 - Accession Number: 104537938. Language: English. Entry Date: 20120530. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Allied Health; Canada; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Gerontologic Care; Oncologic Care; Women's Health. Grant Information: Canadian Breast Cancer Foundation. NLM UID: 101469694. KW - Cancer Patients -- In Old Age KW - Decision Making, Patient -- In Old Age KW - Decision Support Techniques -- In Old Age KW - Breast Neoplasms -- Therapy -- In Old Age KW - Patient Attitudes -- In Old Age KW - Oncologic Care -- In Old Age KW - Interviews KW - Human KW - Pilot Studies KW - Breast Neoplasms -- Classification KW - Qualitative Studies KW - Needs Assessment KW - Focus Groups KW - Cancer Care Facilities KW - Ontario KW - Questionnaires KW - Aged KW - Aged, 80 and Over KW - Female KW - Marital Status KW - Chronic Disease KW - Support, Psychosocial KW - Radiation Therapy Technologists KW - Thematic Analysis KW - Information Needs KW - Breast Neoplasms -- Radiotherapy KW - Breast Neoplasms -- Surgery KW - Lumpectomy KW - Physician-Patient Relations KW - Communication KW - Outpatients KW - Consumer Participation KW - Funding Source KW - Descriptive Statistics SP - 60 EP - 65 JO - Journal of Medical Imaging & Radiation Sciences JF - Journal of Medical Imaging & Radiation Sciences JA - J MED IMAGING RADIAT SCI VL - 43 IS - 1 CY - New York, New York PB - Elsevier B.V. SN - 1939-8654 AD - Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada AD - Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada AD - Education Independent Consultant, Toronto, Ontario, Canada DO - 10.1016/j.jmir.2011.08.005 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104537938&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104518358 T1 - Are We Ready for Online Tools in Decision Making for BRCA1/2 Mutation Carriers? AU - Evans DG AU - Howell A Y1 - 2012/02/10/ N1 - Accession Number: 104518358. Language: English. Entry Date: 20120413. Revision Date: 20150711. Publication Type: Journal Article; commentary. Original Study: Warner E, Hill K, Causer P, Plewes D, Jong R, Yaffe M, et al. Prospective study of breast cancer incidence in women with a BRCA1 or BRCA2 mutation under surveillance with and without magnetic resonance imaging. (J CLIN ONCOL) 5/1/2011; 29 (13): 1664-1669; J Clin Oncol. 2005 Nov 20;23(33):8469-76.; Madalinska JB, Hollenstein J, Bleiker E, van Beurden M, Valdimarsdottir HB, Massuger LF, et al. Quality-of-life effects of prophylactic salpingo-oophorectomy versus gynecologic screening among women at increased risk of hereditary ovarian cancer. (J CLIN ONCOL) 10/1/2005; 23 (28): 6890-6898; Kurian AW, Munoz DF, Rust P, Schackmann EA, Smith M, Clarke L, et al. Online tool to guide decisions for BRCA1/2 mutation carriers. (J CLIN ONCOL) 2/10/2012; 30 (5): 497-506. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Oncologic Care. NLM UID: 8309333. KW - Breast Neoplasms -- Epidemiology KW - Breast Neoplasms -- Prevention and Control KW - Carcinoma, Ductal, Breast -- Epidemiology KW - Computer Simulation KW - Decision Support Techniques KW - Early Detection of Cancer -- Methods KW - Genes, BRCA KW - Disease Susceptibility KW - Magnetic Resonance Imaging KW - Mammography KW - Health Screening -- Methods KW - Mutation KW - Ovarian Neoplasms -- Diagnosis KW - Ovarian Neoplasms -- Prevention and Control KW - Oophorectomy KW - Quality of Life KW - Ultrasonography KW - Female SP - 471 EP - 473 JO - Journal of Clinical Oncology JF - Journal of Clinical Oncology JA - J CLIN ONCOL VL - 30 IS - 5 CY - Alexandria, Virginia PB - American Society of Clinical Oncology SN - 0732-183X AD - Consultant in Clinical Genetics, Genetic Medicine, The University of Manchester, Manchester Academic Health Science Centre, Central Manchester University Hospitals Foundation Trust, St Mary's Hospital, Manchester M13 9WL United Kingdom; gareth.evans@cmft.nhs.uk. U2 - PMID: 22231044. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104518358&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104518360 T1 - Online tool to guide decisions for BRCA1/2 mutation carriers. AU - Kurian AW AU - Munoz DF AU - Rust P AU - Schackmann EA AU - Smith M AU - Clarke L AU - Mills MA AU - Plevritis SK AU - Kurian, Allison W AU - Munoz, Diego F AU - Rust, Peter AU - Schackmann, Elizabeth A AU - Smith, Michael AU - Clarke, Lauren AU - Mills, Meredith A AU - Plevritis, Sylvia K Y1 - 2012/02/10/ N1 - Accession Number: 104518360. Language: English. Entry Date: 20120413. Revision Date: 20161117. Publication Type: journal article; research. Commentary: Evans DG, Howell A. Are We Ready for Online Tools in Decision Making for BRCA1/2 Mutation Carriers? (J CLIN ONCOL) 2/10/2012; 30 (5): 471-473. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Oncologic Care. Grant Information: R01 CA66785/CA/NCI NIH HHS/United States. NLM UID: 8309333. KW - Breast Neoplasms -- Prevention and Control KW - Computer Simulation KW - Decision Support Techniques KW - Early Detection of Cancer -- Methods KW - Genes, BRCA KW - Mutation KW - Ovarian Neoplasms -- Prevention and Control KW - Breast Neoplasms -- Epidemiology KW - Breast Neoplasms KW - Female KW - Disease Susceptibility KW - Heterozygote KW - Human KW - Incidence KW - Magnetic Resonance Imaging KW - Mammography KW - Mastectomy KW - Systems Analysis KW - Ovarian Neoplasms -- Epidemiology KW - Ovarian Neoplasms KW - Oophorectomy KW - Quality of Life KW - Survival Analysis SP - 497 EP - 506 JO - Journal of Clinical Oncology JF - Journal of Clinical Oncology JA - J CLIN ONCOL VL - 30 IS - 5 CY - Alexandria, Virginia PB - American Society of Clinical Oncology AB - Purpose: Women with BRCA1 or BRCA2 (BRCA1/2) mutations must choose between prophylactic surgeries and screening to manage their high risks of breast and ovarian cancer, comparing options in terms of cancer incidence, survival, and quality of life. A clinical decision tool could guide these complex choices.Methods: We built a Monte Carlo model for BRCA1/2 mutation carriers, simulating breast screening with annual mammography plus magnetic resonance imaging (MRI) from ages 25 to 69 years and prophylactic mastectomy (PM) and/or prophylactic oophorectomy (PO) at various ages. Modeled outcomes were cancer incidence, tumor features that shape treatment recommendations, overall survival, and cause-specific mortality. We adapted the model into an online tool to support shared decision making.Results: We compared strategies on cancer incidence and survival to age 70 years; for example, PO plus PM at age 25 years optimizes both outcomes (incidence, 4% to 11%; survival, 80% to 83%), whereas PO at age 40 years plus MRI screening offers less effective prevention, yet similar survival (incidence, 36% to 57%; survival, 74% to 80%). To characterize patients' treatment and survivorship experiences, we reported the tumor features and treatments associated with risk-reducing interventions; for example, in most BRCA2 mutation carriers (81%), MRI screening diagnoses stage I, hormone receptor-positive breast cancers, which may not require chemotherapy.Conclusion: Cancer risk-reducing options for BRCA1/2 mutation carriers vary in their impact on cancer incidence, recommended treatments, quality of life, and survival. To guide decisions informed by multiple health outcomes, we provide an online tool for joint use by patients with their physicians (http://brcatool.stanford.edu). SN - 0732-183X AD - Stanford University School of Medicine, Stanford, CA, USA AD - Department of Radiology, Stanford University School of Medicine, Lucas MRS Imaging Center, Room P267, Stanford, CA 94305-5488; sylvia.plevritis@stanford.edu. U2 - PMID: 22231042. DO - 10.1200/JCO.2011.38.6060 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104518360&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104632829 T1 - Improved modeling of clinical data with kernel methods. AU - Daemen A AU - Timmerman D AU - Van den Bosch T AU - Bottomley C AU - Kirk E AU - Van Holsbeke C AU - Valentin L AU - Bourne T AU - De Moor B Y1 - 2012/02// N1 - Accession Number: 104632829. Language: English. Entry Date: 20120525. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Blind Peer Reviewed; Computer/Information Science; Continental Europe; Europe; Expert Peer Reviewed; Peer Reviewed. Special Interest: Informatics. NLM UID: 8915031. KW - Artificial Intelligence KW - Data Mining -- Methods KW - Decision Support Systems, Clinical KW - Decision Support Techniques KW - Patient Record Systems KW - Algorithms KW - Adult KW - Age Factors KW - Aged KW - Aged, 80 and Over KW - Pharmacokinetics KW - Statistics KW - Breast Neoplasms -- Diagnosis KW - Breast Neoplasms -- Therapy KW - Female KW - Gynecology KW - Human KW - Regression KW - Linear Regression KW - Middle Age KW - Chaos Theory KW - Pregnancy KW - Prognosis KW - Young Adult SP - 103 EP - 114 JO - Artificial Intelligence in Medicine JF - Artificial Intelligence in Medicine JA - ARTIF INTELL MED VL - 54 IS - 2 PB - Elsevier B.V. SN - 0933-3657 AD - Department of Electrical Engineering, Katholieke Universiteit Leuven, 3001 Leuven, Belgium. U2 - PMID: 22134094. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104632829&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 108222542 T1 - Radiation therapy for ductal carcinoma in situ: a decision analysis. AU - Punglia RS AU - Burstein HJ AU - Weeks JC AU - Punglia, Rinaa S AU - Burstein, Harold J AU - Weeks, Jane C Y1 - 2012/02// N1 - Accession Number: 108222542. Language: English. Entry Date: 20120406. Revision Date: 20161125. Publication Type: journal article; research. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Oncologic Care. Grant Information: K05 CA166208/CA/NCI NIH HHS/United States. NLM UID: 0374236. KW - Breast Neoplasms -- Radiotherapy KW - Carcinoma, Ductal, Breast -- Radiotherapy KW - Adenocarcinoma -- Radiotherapy KW - Decision Support Techniques KW - Neoplasm Recurrence, Local -- Radiotherapy KW - Aged KW - Breast Neoplasms -- Mortality KW - Breast Neoplasms -- Surgery KW - Carcinoma, Ductal, Breast -- Mortality KW - Carcinoma, Ductal, Breast -- Surgery KW - Adenocarcinoma -- Mortality KW - Adenocarcinoma -- Surgery KW - Combined Modality Therapy KW - Prognosis KW - Female KW - Prospective Studies KW - Human KW - Probability KW - Mastectomy KW - Middle Age KW - Neoplasm Recurrence, Local -- Mortality KW - Neoplasm Recurrence, Local -- Surgery KW - Radiotherapy, Adjuvant KW - Survival KW - Treatment Outcomes SP - 603 EP - 611 JO - Cancer (0008543X) JF - Cancer (0008543X) JA - CANCER VL - 118 IS - 3 CY - Hoboken, New Jersey PB - John Wiley & Sons, Inc. AB - Background: The benefit of adding radiation therapy after excision of ductal carcinoma in situ (DCIS) is widely debated. Randomized clinical trials are underpowered to delineate long-term outcomes after radiation.Methods: The authors of this report constructed a Markov decision model to simulate the clinical course of DCIS in a woman aged 60 years who received treatment with either of 2 breast-conserving strategies: excision alone or excision plus radiation therapy. Sensitivity analyses were used to study the influence of risk of local recurrence, likelihood of invasive disease at recurrence, surgical choice at recurrence, and patient age at diagnosis on treatment outcomes.Results: The addition of radiation therapy was associated with slight improvements in invasive disease-free and overall survival. However, radiation therapy decreased the chance of having both breasts intact over a patient's lifetime. Radiation therapy improved survival by 2.1 months for women who were diagnosed with DCIS at age 60 years but decreased the chance of having both breasts by 8.6% relative to excision alone. The differences in outcomes between the treatment strategies became smaller with increasing age at diagnosis. Sensitivity analyses revealed a greater benefit for radiation with an increased likelihood of invasive recurrence. The decrement in breast preservation with radiation therapy was mitigated by an increased likelihood of mastectomy at the time of recurrence or new breast cancer diagnosis.Conclusions: The current analysis quantified the benefits of radiation after excision of DCIS but also revealed that radiation therapy may increase the likelihood of eventual mastectomy. Therefore, the authors concluded that patient age and preferences should be considered when making the decision to add or forgo radiation for DCIS. SN - 0008-543X AD - Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA AD - Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. rpunglia@lroc.harvard.edu. U2 - PMID: 21720992. DO - 10.1002/cncr.26293 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=108222542&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 108086508 T1 - Comorbidity as a mediator of survival disparity between younger and older women diagnosed with metastatic breast cancer. AU - Jung SY AU - Rosenzweig M AU - Linkov F AU - Brufsky A AU - Weissfeld JL AU - Sereika SM AU - Jung, Su Yon AU - Rosenzweig, Margaret AU - Linkov, Faina AU - Brufsky, Adam AU - Weissfeld, Joel L AU - Sereika, Susan M Y1 - 2012/02// N1 - Accession Number: 108086508. Language: English. Entry Date: 20130104. Revision Date: 20160728. Publication Type: journal article; research. Journal Subset: Biomedical; USA. Instrumentation: Charlson Comorbidity Index (CCI). NLM UID: 7906255. KW - Breast Neoplasms -- Epidemiology KW - Breast Neoplasms -- Mortality KW - Hypertension -- Epidemiology KW - Adult KW - Age Factors KW - Aged KW - Aged, 80 and Over KW - Breast Neoplasms KW - Clinical Assessment Tools KW - Comorbidity KW - Female KW - Human KW - Logistic Regression KW - Middle Age KW - Retrospective Design KW - Survival SP - 205 EP - 211 JO - Hypertension (0194911X) JF - Hypertension (0194911X) JA - HYPERTENSION (0194911X) VL - 59 IS - 2 CY - Baltimore, Maryland PB - Lippincott Williams & Wilkins AB - The presence of comorbidity becomes increasingly important for its prognostic effect on survival in breast cancer patients with advancing age. This study aimed to evaluate the role of comorbidities including hypertension as a mediator of disparity in survival after metastasis diagnosis between younger (≤51 years) and older (>51 years) patients. A total of 553 patients 26-88 years of age with breast cancer metastasis diagnosis from 1 large urban practice were followed between January 1, 1999, and June 30, 2008. Comorbidity variables and survival were analyzed using Cox regression model. To assess comorbidity variables as a mediator of age-survival relationship, 2 approaches have been applied: (1) Baron Kenny approach and (2) alternative assessment to compute the percentage change in the hazard ratios (HRs). The median survival was 40 months, with 265 (47.9%) alive and 288 (52.1%) dead. Older patients had worse survival than younger patients (HR, 1.43; 95% confidence interval [CI], 1.11-1.84). Hypertension was related to survival (HR, 1.45; 95% CI, 1.12-1.89) when age and other covariates were controlled. The effect of age on survival was no longer significant after adjustment for hypertension (HR, 1.26; 95%, CI 0.97-1.65) or hypertension-augmented Charlson comorbidity score (HR, 1.24; 95% CI, 0.95-1.63). Hypertension-augmented Charlson comorbidity score or hypertension was a strong mediator of age-survival relationship among metastatic breast cancer patients, explaining survival disparity between younger and older patients by 44% and 40%, respectively. The study findings suggest that hypertension should be included in the comorbidity information for decision-making support programs. SN - 0194-911X AD - Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA AD - Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA. suj11@pitt.edu U2 - PMID: 22184319. DO - 10.1161/HYPERTENSIONAHA.111.171736 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=108086508&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104533061 T1 - Theory-based design and field-testing of an intervention to support women choosing surgery for breast cancer: BresDex. AU - Sivell S AU - Marsh W AU - Edwards A AU - Manstead AS AU - Clements A AU - Elwyn G AU - Sivell, Stephanie AU - Marsh, William AU - Edwards, Adrian AU - Manstead, Antony S R AU - Clements, Alison AU - Elwyn, Glyn Y1 - 2012/02// N1 - Accession Number: 104533061. Corporate Author: BresDex group. Language: English. Entry Date: 20120504. Revision Date: 20171115. Publication Type: journal article; research. Journal Subset: Core Nursing; Europe; Health Promotion/Education; Nursing; Peer Reviewed; UK & Ireland. Grant Information: MCCC-FCO-11-C//Marie Curie/United Kingdom. NLM UID: 8406280. KW - Breast Neoplasms -- Surgery KW - Decision Making KW - Decision Support Techniques KW - Mastectomy -- Psychosocial Factors KW - Adult KW - Aged KW - Breast Neoplasms -- Psychosocial Factors KW - Female KW - Human KW - Intention KW - Experimental Studies KW - Interviews KW - Middle Age KW - Neoplasm Staging KW - Consumer Participation KW - Psychological Theory KW - Qualitative Studies KW - Reproducibility of Results SP - 179 EP - 188 JO - Patient Education & Counseling JF - Patient Education & Counseling JA - PATIENT EDUC COUNS VL - 86 IS - 2 PB - Elsevier B.V. AB - Objective: Design and undertake usability and field-testing evaluation of a theory-guided decision aid (BresDex) in supporting women choosing surgery for early breast cancer.Methods: An extended Theory of Planned Behavior (TPB) and the Common Sense Model of Illness Representations (CSM) guided the design of BresDex. BresDex was evaluated and refined across 3 cycles by interviewing 6 women without personal history of breast cancer, 8 women with personal history of breast cancer who had completed treatment and 11 women newly diagnosed with breast cancer. Participants were interviewed for views on content, presentation (usability) and perceived usefulness towards deciding on treatment (utility). Framework analysis was used, guided by the extended TPB and the CSM.Results: BresDex was positively received in content and presentation (usability). It appeared an effective support to decision-making and useful source for further information, particularly in clarifying attitudes, social norms and perceived behavioral control, and presenting consequences of decisions (utility).Conclusion: This study illustrates the potential benefit of the extended TPB and CSM in designing a decision aid to support women choosing breast cancer surgery.Practice Implications: BresDex could provide decision-making support and serve as an additional source of information, to complement the care received from the clinical team. SN - 0738-3991 AD - Marie Curie Palliative Care Research Group, Wales Cancer Trials Unit, School of Medicine, Cardiff University, Cardiff, UK AD - Marie Curie Palliative Care Research Group, Wales Cancer Trials Unit, School of Medicine, Cardiff University, Cardiff, UK. sivells2@cardiff.ac.uk U2 - PMID: 21571485. DO - 10.1016/j.pec.2011.04.014 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104533061&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104508502 T1 - Impact of decision aids in a sustained implementation at a breast care center. AU - Belkora JK AU - Volz S AU - Teng AE AU - Moore DH AU - Loth MK AU - Sepucha KR Y1 - 2012/02// N1 - Accession Number: 104508502. Language: English. Entry Date: 20120504. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Core Nursing; Europe; Health Promotion/Education; Nursing; Peer Reviewed; UK & Ireland. NLM UID: 8406280. KW - Breast Neoplasms -- Diagnosis KW - Breast Neoplasms -- Psychosocial Factors KW - Breast Neoplasms -- Surgery KW - Decision Making KW - Decision Support Techniques KW - Attitude to Health KW - Adult KW - Aged KW - Female KW - Human KW - Middle Age KW - Patient Education -- Methods KW - Consumer Participation KW - Program Development KW - Program Evaluation KW - California KW - Socioeconomic Factors SP - 195 EP - 204 JO - Patient Education & Counseling JF - Patient Education & Counseling JA - PATIENT EDUC COUNS VL - 86 IS - 2 PB - Elsevier B.V. AB - OBJECTIVE: We examined the reach and impact of five decision aids (DAs) routinely distributed to breast cancer patients as part of a shared decision making demonstration project. METHODS: From 2005 to 2008, we surveyed patients' change in knowledge and decisional conflict (DC) before and after their review of DAs. Using bivariate tests, we identified significant predictors of change in knowledge or decisional conflict and entered significant predictors into a multivariate regression model. RESULTS: We distributed 1553 DAs to 1098 patients and received 549 completed surveys. The DAs were associated with increased knowledge and decreased DC. For knowledge, significant predictors of above-average change included: lower baseline knowledge and viewing the surgery decision aid. For decisional conflict, significant predictors of above-average change included: higher decisional conflict; viewing any of the early-stage cancer DAs; and Hispanic ethnicity. CONCLUSIONS: DAs used in routine care were associated with significant knowledge gains and reductions in decisional conflict. Some subsets of patients (those reporting low baseline knowledge, high DC, or Hispanic ethnicity) may benefit more than others. PRACTICE IMPLICATIONS: Breast cancer patients benefit overall from routine distribution of DAs. Our exploratory findings may be useful in generating hypotheses to identify target populations who would most benefit from reviewing DAs. SN - 0738-3991 AD - Institute for Health Policy Studies, University of California, San Francisco, USA. U2 - PMID: 21665420. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104508502&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104360430 T1 - Measuring decision quality: psychometric evaluation of a new instrument for breast cancer surgery. AU - Sepucha, Karen R AU - Belkora, Jeffrey K AU - Chang, Yuchiao AU - Cosenza, Carol AU - Levin, Carrie A AU - Moy, Beverly AU - Partridge, Ann AU - Lee, Clara N Y1 - 2012/01// N1 - Accession Number: 104360430. Language: English. Entry Date: 20130607. Revision Date: 20161117. Publication Type: journal article; research. Journal Subset: Biomedical; Computer/Information Science; Europe; UK & Ireland. Special Interest: Informatics. Grant Information: 1KL2RR025746/RR/NCRR NIH HHS/United States. NLM UID: 101088682. KW - Breast Neoplasms -- Surgery KW - Quality of Life KW - Adult KW - Cross Sectional Studies KW - Decision Support Techniques KW - Pilot Studies KW - Female KW - Surveys KW - Human KW - Middle Age KW - Psychometrics KW - Reproducibility of Results SP - 51 EP - 51 JO - BMC Medical Informatics & Decision Making JF - BMC Medical Informatics & Decision Making JA - BMC MED INFORM DECIS MAKING VL - 12 IS - 1 PB - BioMed Central AB - Background: The purpose of this paper is to examine the acceptability, feasibility, reliability and validity of a new decision quality instrument that assesses the extent to which patients are informed and receive treatments that match their goals.Methods: Cross-sectional mail survey of recent breast cancer survivors, providers and healthy controls and a retest survey of survivors. The decision quality instrument includes knowledge questions and a set of goals, and results in two scores: a breast cancer surgery knowledge score and a concordance score, which reflects the percentage of patients who received treatments that match their goals. Hypotheses related to acceptability, feasibility, discriminant validity, content validity, predictive validity and retest reliability of the survey instrument were examined.Results: We had responses from 440 eligible patients, 88 providers and 35 healthy controls. The decision quality instrument was feasible to implement in this study, with low missing data. The knowledge score had good retest reliability (intraclass correlation coefficient=0.70) and discriminated between providers and patients (mean difference 35%, p<0.001). The majority of providers felt that the knowledge items covered content that was essential for the decision. Five of the 6 treatment goals met targets for content validity. The five goals had moderate to strong retest reliability (0.64 to 0.87). The concordance score was 89%, indicating that a majority had treatments concordant with that predicted by their goals. Patients who had concordant treatment had similar levels of confidence and regret as those who did not.Conclusions: The decision quality instrument met the criteria of feasibility, reliability, discriminant and content validity in this sample. Additional research to examine performance of the instrument in prospective studies and more diverse populations is needed. SN - 1472-6947 AD - General Medicine Division, Massachusetts General Hospital, 50 Staniford Street, 9th floor, Boston, MA, 02114, USA. ksepucha@partners.org. U2 - PMID: 22681763. DO - 10.1186/1472-6947-12-51 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104360430&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104360299 T1 - Prediction of axillary lymph node metastasis in primary breast cancer patients using a decision tree-based model. AU - Takada, Masahiro AU - Sugimoto, Masahiro AU - Naito, Yasuhiro AU - Moon, Hyeong-Gon AU - Han, Wonshik AU - Noh, Dong-Young AU - Kondo, Masahide AU - Kuroi, Katsumasa AU - Sasano, Hironobu AU - Inamoto, Takashi AU - Tomita, Masaru AU - Toi, Masakazu Y1 - 2012/01// N1 - Accession Number: 104360299. Language: English. Entry Date: 20130607. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Computer/Information Science; Europe; UK & Ireland. Special Interest: Informatics. NLM UID: 101088682. KW - Breast Neoplasms -- Pathology KW - Decision Trees KW - Data Mining KW - Female KW - Human KW - Lymph Nodes -- Pathology KW - Lymph Nodes -- Surgery KW - Neoplasm Metastasis KW - Models, Biological KW - ROC Curve KW - Sentinel Lymph Node Biopsy SP - 54 EP - 54 JO - BMC Medical Informatics & Decision Making JF - BMC Medical Informatics & Decision Making JA - BMC MED INFORM DECIS MAKING VL - 12 IS - 1 PB - BioMed Central SN - 1472-6947 AD - Department of Breast Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan. toi@kuhp.kyoto-u.ac.jp. U2 - PMID: 22695278. DO - 10.1186/1472-6947-12-54 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104360299&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104411546 T1 - Patient understanding of the revised USPSTF screening mammogram guidelines: need for development of patient decision aids. AU - Allen, Summer V AU - Solberg Nes, Lise AU - Marnach, Mary L AU - Polga, Kristen AU - Jenkins, Sarah M AU - Files, Julia A AU - Croghan, Ivana T AU - Ghosh, Karthik AU - Pruthi, Sandhya Y1 - 2012/01// N1 - Accession Number: 104411546. Language: English. Entry Date: 20130726. Revision Date: 20150711. Publication Type: Journal Article. Journal Subset: Biomedical; Europe; UK & Ireland. Special Interest: Women's Health. NLM UID: 101088690. KW - Breast Neoplasms -- Prevention and Control KW - Early Detection of Cancer -- Psychosocial Factors KW - Mammography -- Standards KW - Health Screening -- Standards KW - Patient Attitudes KW - Practice Guidelines KW - Adult KW - Policy Making KW - Aged KW - Breast Neoplasms -- Diagnosis KW - Breast Neoplasms -- Psychosocial Factors KW - Centers for Disease Control and Prevention (U.S.) KW - Female KW - Mammography -- Psychosocial Factors KW - Health Screening -- Psychosocial Factors KW - Middle Age KW - United States KW - Young Adult SP - 36 EP - 36 JO - BMC Women's Health JF - BMC Women's Health JA - BMC WOMENS HEALTH VL - 12 IS - 1 PB - BioMed Central SN - 1472-6874 AD - Division of General Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. pruthi.sandhya@mayo.edu. U2 - PMID: 23051022. DO - 10.1186/1472-6874-12-36 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104411546&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 108216425 T1 - Follow-up versus tissue diagnosis in BI-RADS category 3 solid breast lesions at US: a cost-consequence analysis. AU - Alimoglu E AU - Bayraktar SD AU - Bozkurt S AU - Ceken K AU - Kabaalioglu A AU - Apaydin A AU - Sindel HT AU - Alimoğlu, Emel AU - Bayraktar, Şule Doğan AU - Bozkurt, Selen AU - Çeken, Kağan AU - Kabaalioğlu, Adnan AU - Apaydın, Ali AU - Sindel, Hakkı Timur Y1 - 2012/01//2012 Jan N1 - Accession Number: 108216425. Language: English. Entry Date: 20120615. Revision Date: 20170411. Publication Type: journal article; research. Journal Subset: Biomedical; Middle East. NLM UID: 101241152. KW - Breast Neoplasms -- Economics KW - Breast Neoplasms -- Ultrasonography KW - Adult KW - Aged KW - Breast Neoplasms -- Classification KW - Costs and Cost Analysis KW - Decision Trees KW - Female KW - Prospective Studies KW - Human KW - Middle Age SP - 3 EP - 10 JO - Diagnostic & Interventional Radiology JF - Diagnostic & Interventional Radiology JA - DIAGN INTERVENT RADIOL VL - 18 IS - 1 PB - Aves Yayincilik Ltd. STI AB - Purpose: The aim of this study was to compare the economic effect of a proposed follow-up strategy for managing category 3 breast masses. The strategy incorporated direct tissue diagnosis at the patient's discretion for masses that had been assessed only based on ultrasonography (US) and for which mammography made no diagnostic contribution. Materials and Methods: This prospective cohort study was conducted between 2003 and 2006 and included 174 patients. We used a two-year short-term follow-up protocol composed of five steps. A biopsy was recommended for masses that were increasing in size and changing in nature. The long-term results were available at the end of 2010. The mean and total costs were calculated for the women who preferred our follow-up protocol and for those who preferred direct tissue diagnosis. The cost savings were calculated by comparing the costs of the current study protocol to the costs of two different scenarios. Results: Two malignancies were found among the 18 women who underwent tissue diagnosis on the recommendation of the radiologist during follow-up. Thirteen of these women underwent biopsy at the request of the patient or surgeon, and these biopsies all revealed benign tumors. The overall negative predictive value was 99.2% (95% confidence interval, 98.46%-100%). There was a statistically significant difference between the mean costs for the women who chose our follow- up regimen (147.57±106.7 TL) and those who preferred direct tissue diagnosis (426.89±149.8 TL) (P = 0.0001). The use of our follow-up protocol decreased the cost of diagnosis by 60% compared with the cost of using direct tissue diagnosis as the initial procedure. Conclusion: Our long-term results indicate that following-up solid category 3 masses detected only by US for at least two years at short intervals is a cost-effective alternative to direct breast biopsy. SN - 1305-3825 AD - Department of Radiology, Akdeniz University School of Medicine Antalya, Turkey AD - From the Departments of Radiology, Akdeniz University School of Medicine Antalya, Turkey. U2 - PMID: 21997885. DO - 10.4261/1305-3825.DIR.4462-11.1 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=108216425&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - THES ID - 109860313 T1 - The experience of cancer risk management decision making for BRCA+ women. AU - Leonarczyk, Terri Jabaley Y1 - 2012/01// N1 - Accession Number: 109860313. Language: English. Entry Date: 20130913. Revision Date: 20150923. Publication Type: Doctoral Dissertation; research. Special Interest: Women's Health. KW - Breast Neoplasms -- Risk Factors KW - Genes, BRCA KW - Genetic Screening KW - Risk Management -- Methods KW - Communication -- Methods KW - Decision Making, Patient KW - Female KW - Human KW - Phenomenological Research KW - Qualitative Studies KW - Semi-Structured Interview KW - Support Groups KW - Thematic Analysis KW - Truth Disclosure SP - 120 p EP - 120 p JO - Experience of Cancer Risk Management Decision Making for Brca+ Women JF - Experience of Cancer Risk Management Decision Making for Brca+ Women PB - University of Massachusetts Lowell AB - Genetic testing for BRCA mutations presents an opportunity for identifying women at significantly increased risk for developing breast and ovarian cancer (NCCN, 2011). The phenomenon of cancer risk management decision making for BRCA+ women is complex and has life altering implications. Current recommendations for BRCA+ women are not clearly defined and vary based on individual factors (Balmana, Diez, Rubio, & Castiglione, 2010; NCCN, 2011; NCI, 2011). This qualitative, phenomenological study explored the experience of cancer risk management decision making for women who are unaffected carriers of a BRCA mutation (previvors). Semi-structured interviews were conducted with fifteen previvors recruited from an online informational and support group, Facing our Risk of Cancer Empowered (FORCE). Four major themes emerged from the data: 1. The early previvor experience of intense emotional upheaval; 2. The decisional journey: Navigating a personal plan for survival; 3. The lack of knowledge and experience among health care providers; 4. Support for previvors is essential. For previvors, the experience of cancer risk management decision making was a complex intellectual and emotional journey involving a process of weighing risks and benefits of options for cancer risk management within a personal, individual context. The experience was viewed as a journey, characterized by choices that changed over time. Several implications of the findings were identified. Previvors should have genetic counseling and support mechanisms in place before, during and after BRCA testing as the decisional journey ensues. Contrary to previous studies, previvors expressed a preference for receiving notification of positive genetic testing results in person rather than by telephone or mail. Ongoing counseling, assessment of support needs, and referrals to support groups are important throughout the cancer risk management decision making process. Improved education and increased knowledge among health care providers are needed. The development of educational and decisional support resources for this population is essential. SN - 9781267517456 AV - UMI Order AAI3520081 M1 - Ph.D. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109860313&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104506730 T1 - Breast Cancer-Related Lymphedema: Comparing Direct Costs of a Prospective Surveillance Model and a Traditional Model of Care. AU - Stout, Nicole L. AU - Pfalzer, Lucinda A. AU - Springer, Barbara AU - Levy, Ellen AU - McGarvey, Charles L. AU - Danoff, Jerome V. AU - Gerber, Lynn H. AU - Soballe, Peter W. Y1 - 2012/01// N1 - Accession Number: 104506730. Language: English. Entry Date: 20120127. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Allied Health; Peer Reviewed; USA. Special Interest: Oncologic Care; Physical Therapy. Grant Information: This work was supported by intramural funding through the US Department of Defense and the National Institutes of Health.. NLM UID: 0022623. KW - Breast Neoplasms -- Complications KW - Lymphedema -- Prevention and Control KW - Patient Care -- Methods KW - Lymphedema -- Economics KW - Health Care Costs KW - Disease Surveillance -- Methods KW - Disease Surveillance -- Economics KW - Early Intervention KW - Cost Savings KW - Costs and Cost Analysis KW - Physical Therapy KW - Decision Trees KW - Funding Source KW - Human SP - 152 EP - 163 JO - Physical Therapy JF - Physical Therapy JA - PHYS THER VL - 92 IS - 1 PB - Oxford University Press / USA AB - Secondary prevention involves monitoring and screening to prevent negative sequelae from chronic diseases such as cancer. Breast cancer treatment sequelae, such as lymphedema, may occur early or late and often negatively affect function. Secondary prevention through prospective physical therapy surveillance aids in early identification and treatment of breast cancer-related lymphedema (BCRL). Early intervention may reduce the need for intensive rehabilitation and may be cost saving. This perspective article compares a prospective surveillance model with a traditional model of impairment-based care and examines direct treatment costs associated with each program. Intervention and supply costs were estimated based on the Medicare 2009 physician fee schedule for 2 groups: (1) a prospective surveillance model group (PSM group) and (2) a traditional model group (TM group). The PSM group comprised all women with breast cancer who were receiving interval prospective surveillance, assuming that one third would develop early-stage BCRL. The prospective surveillance model includes the cost of screening all women plus the cost of intervention for early-stage BCRL. The TM group comprised women referred for BCRL treatment using a traditional model of referral based on late-stage lymphedema. The traditional model cost includes the direct cost of treating patients with advanced-stage lymphedema. The cost to manage early-stage BCRL per patient per year using a prospective surveillance model is $636.19. The cost to manage late-stage BCRL per patient per year using a traditional model is $3,124.92. The prospective surveillance model is emerging as the standard of care in breast cancer treatment and is a potential cost-saving mechanism for BCRL treatment. Further analysis of indirect costs and utility is necessary to assess cost-effectiveness. A shift in the paradigm of physical therapy toward a prospective surveillance model is warranted. SN - 0031-9023 AD - National Naval Medical Center, Breast Care Center, 8901 Wisconsin Ave, Bldg 10, 4 West, Bethesda, MD 20814 (USA) AD - Department of Physical Therapy, University of Michigan-Flint, Flint, Michigan AD - Proponency Office for Rehabilitation and Reintegration, Office of the Surgeon General, Falls Church, Virginia AD - Rehabilitation Medicine Department, National Institutes of Health, Bethesda, Maryland AD - CLM Consulting, Rockville, Maryland AD - Rehabilitation Medicine Department, National Institutes of Health, and School of Public Health and Health Services, George Washington University, Washington, DC AD - George Mason University, Fairfax, Virginia AD - Naval Hospital, San Diego, California U2 - PMID: 21921254. DO - 10.2522/ptj.20100167 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104506730&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104631836 T1 - Breast cancer treatment decision aid. AU - Napoli, Maryann Y1 - 2011/12// N1 - Accession Number: 104631836. Language: English. Entry Date: 20120206. Revision Date: 20150711. Publication Type: Journal Article; brief item. Journal Subset: Consumer Health; USA. Special Interest: Consumer Health. KW - Breast Neoplasms -- Therapy KW - Decision Making -- Methods KW - World Wide Web KW - Survival Analysis KW - Chemotherapy, Adjuvant SP - 1 EP - 1 JO - Center for Medical Consumers JF - Center for Medical Consumers JA - CENT MED CONSUM CY - New York, New York PB - Center for Medical Consumers, Inc. SN - 2155-1480 AD - Center for Medical Consumers UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104631836&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104598843 T1 - Development and pilot-testing of a Decision Aid for use among Chinese women facing breast cancer surgery. AU - Au, Angel H.Y. AU - Lam, Wendy W.T. AU - Chan, Miranda C.M. AU - Or, Amy Y.M. AU - Kwong, Ava AU - Suen, Dacita AU - Wong, Annie L. AU - Juraskova, Ilona AU - Wong, Teresa W.T. AU - Fielding, Richard Y1 - 2011/12// N1 - Accession Number: 104598843. Language: English. Entry Date: 20120316. Revision Date: 20150711. Publication Type: Journal Article; pictorial; research; tables/charts. Journal Subset: Europe; Health Services Administration; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care; Women's Health. Instrumentation: Hospital Anxiety and Depression Scale (HADS); Preparation for Decision Making (Graham and O'Connor) [Chinese]. Grant Information: This work was funded by Hong Kong Cancer Fund 2007 ⁄ 2008.. NLM UID: 9815926. KW - Decision Support Techniques -- Evaluation -- China KW - Decision Making, Patient KW - Breast Neoplasms -- Surgery KW - Pilot Studies KW - Female KW - Adult KW - China KW - Funding Source KW - Questionnaires KW - Chi Square Test KW - Teaching Materials KW - Convenience Sample KW - Coefficient Alpha KW - Scales KW - Descriptive Statistics KW - Psychological Tests KW - T-Tests KW - One-Way Analysis of Variance KW - Data Analysis Software KW - Mastectomy KW - Lumpectomy KW - Breast Reconstruction KW - Post Hoc Analysis KW - Stress, Psychological KW - Cross Sectional Studies KW - Breast Neoplasms -- Psychosocial Factors SP - 405 EP - 416 JO - Health Expectations JF - Health Expectations JA - HEALTH EXPECTATIONS VL - 14 IS - 4 CY - Malden, Massachusetts PB - Wiley-Blackwell AB - Background Women choosing breast cancer surgery encounter treatment decision-making (TDM) difficulties, which can cause psychological distress. Decision Aids (DAs) may facilitate TDM, but there are no DAs designed for Chinese populations. We developed a DA for Chinese women newly diagnosed with breast cancer, for use during the initial surgical consultation. Aims Conduct a pilot study to assess the DA acceptability and utility among Chinese women diagnosed with breast cancer. Methods Women preferred the DA in booklet format. A booklet was developed and revised and evaluated in two consecutive pilot studies (P1 and P2). On concluding their initial diagnostic consultation, 95 and 38 Chinese women newly diagnosed with breast cancer received the draft and revised draft DA booklet, respectively. Four-day post-consultation, women had questionnaires read out to them and to which they responded assessing attitudes towards the DA and their understanding of treatment options. Results The original DA was read/partially read by 66/22% ( n = 84) of women, whilst the revised version was read/partially read by 74/16% ( n = 35), including subliterate women (χ2 = 0.76, P = 0.679). Knowledge scores varied with the extent the booklet was read (P1: F = 12.68, d.f. 2, P < 0.001; P2: F = 3.744, d.f. 2, P = 0.034). The revised, shorter version was graphically rich and resulted in improved perceived utility, [except for the 'treatment options' (χ2 = 5.50, P = 0.019) and 'TDM guidance' (χ2 = 8.19, P = 0.004) sections] without increasing anxiety ( F = 0.689, P = 0.408; F = 3.45, P = 0.073). Conclusion The DA was perceived as acceptable and useful for most women. The DA effectiveness is currently being evaluated using a randomized controlled trial. SN - 1369-6513 AD - Post-Graduate Research Student AD - Assitant Professor, Centre for Psycho-Oncological Research & Training, School of Public Health, The University of Hong Kong, Hong Kong, China AD - Consultant AD - Breast Nurse Specialist, Department of Surgery, Breast Centre, Kwong Wah Hospital, Hong Kong, China AD - Chief of Division of Breast Surgery AD - Associate Consultant, Breast Centre, Tung Wah Hospital and Queen Mary Hospital, The University of Hong Kong, Hong Kong, China AD - Breast Nurse Specialist, Breast Centre, Tung Wah Hospital, Hong Kong, China AD - Lecturer in Health Psychology, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, Sydney, NSW, Australia AD - Professor, Centre for Psycho-Oncological Research & Training, School of Public Health, The University of Hong Kong, Hong Kong, China U2 - PMID: 21223468. DO - 10.1111/j.1369-7625.2010.00655.x UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104598843&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104598398 T1 - Decision aids for surgical treatment of early stage breast cancer: A narrative review of the literature. AU - Obeidat R AU - Finnell DS AU - Lally RM Y1 - 2011/12// N1 - Accession Number: 104598398. Language: English. Entry Date: 20120525. Revision Date: 20150711. Publication Type: Journal Article; research; systematic review. Journal Subset: Core Nursing; Europe; Health Promotion/Education; Nursing; Peer Reviewed; UK & Ireland. Special Interest: Evidence-Based Practice. NLM UID: 8406280. KW - Breast Neoplasms -- Surgery KW - Decision Making KW - Decision Support Techniques KW - Patient Education KW - Consumer Participation KW - Female KW - Human KW - Narratives KW - Quality of Life KW - Treatment Outcomes SP - e311 EP - 21 JO - Patient Education & Counseling JF - Patient Education & Counseling JA - PATIENT EDUC COUNS VL - 85 IS - 3 PB - Elsevier B.V. AB - OBJECTIVE: To review and critique the published empirical research on decision aids for women actually facing surgical treatment of early stage breast cancer, synthesize findings across studies related to outcomes of decision aids use with specific attention to the influence of system and client characteristics, and identify opportunities for further research. METHODS: A systematic and reproducible search was carried out to identify studies evaluating decision aids for women making breast cancer surgical treatment decisions. All included studies were appraised. RESULTS: Most studies evaluated the outcomes of decision aids use in terms of final treatment decisions, patients' knowledge of treatment options, anxiety, decisional conflict, satisfaction and quality of life. Included studies varied in design, measures used to assess effectiveness, format of the aids, patient populations and clinical settings. Studies yielded mixed results related to the effect of the decision aids on the outcomes measured. CONCLUSION: Despite the mixed findings of the studies, some support exists for the use of decision aids with women diagnosed with early stage breast cancer. PRACTICE IMPLICATIONS: To ensure successful implementation of decision aids in clinical practice, healthcare providers should be educated on their use. Greater allocation of time, space and access to decision aids is also needed. SN - 0738-3991 AD - School of Nursing, University at Buffalo, The State University of New York, Buffalo, USA. U2 - PMID: 21543184. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104598398&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104589533 T1 - Decision aid for women considering breast cancer screening. AU - Pasternack I AU - Saalasti-Koskinen U AU - Mäkelä M Y1 - 2011/10// N1 - Accession Number: 104589533. Language: English. Entry Date: 20120907. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Europe; UK & Ireland. Special Interest: Laboratory Diagnosis. NLM UID: 8508113. KW - Breast Neoplasms -- Diagnosis KW - Decision Support Techniques KW - Communication -- Methods KW - Health Screening -- Methods KW - Female KW - Finland KW - Human KW - Mammography SP - 357 EP - 362 JO - International Journal of Technology Assessment in Health Care JF - International Journal of Technology Assessment in Health Care JA - INT J TECHNOL ASSESS HEALTH CARE VL - 27 IS - 4 PB - Cambridge University Press SN - 0266-4623 AD - FINOHTA (Finnish Office for Health Technology Assessment), at THL (National Institute for Health and Welfare). U2 - PMID: 22004777. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104589533&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104589534 T1 - Health technology assessment-based development of a Spanish breast cancer patient decision aid. AU - Izquierdo F AU - Gracia J AU - Guerra M AU - Blasco JA AU - Andradas E Y1 - 2011/10// N1 - Accession Number: 104589534. Language: English. Entry Date: 20120907. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Europe; UK & Ireland. Special Interest: Laboratory Diagnosis. NLM UID: 8508113. KW - Breast Neoplasms -- Diagnosis KW - Decision Support Techniques KW - Attitude to Health KW - Consumer Participation KW - Quality Assessment -- Administration KW - Adolescence KW - Adult KW - Aged KW - Female KW - Human KW - Middle Age KW - Patient Education KW - Socioeconomic Factors KW - Spain KW - Young Adult SP - 363 EP - 368 JO - International Journal of Technology Assessment in Health Care JF - International Journal of Technology Assessment in Health Care JA - INT J TECHNOL ASSESS HEALTH CARE VL - 27 IS - 4 PB - Cambridge University Press SN - 0266-4623 AD - Agencia Laín Entralgo. U2 - PMID: 22004778. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104589534&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104582599 T1 - Mutual information-based template matching scheme for detection of breast masses: from mammography to digital breast tomosynthesis. AU - Mazurowski MA AU - Lo JY AU - Harrawood BP AU - Tourassi GD AU - Mazurowski, Maciej A AU - Lo, Joseph Y AU - Harrawood, Brian P AU - Tourassi, Georgia D Y1 - 2011/10// N1 - Accession Number: 104582599. Language: English. Entry Date: 20120504. Revision Date: 20161125. Publication Type: journal article; research. Journal Subset: Biomedical; Computer/Information Science; Peer Reviewed; USA. Special Interest: Informatics. Grant Information: R01 CA112437/CA/NCI NIH HHS/United States. NLM UID: 100970413. KW - Breast -- Pathology KW - Mammography -- Methods KW - Radiographic Image Interpretation, Computer-Assisted -- Methods KW - Algorithms KW - Breast Neoplasms -- Diagnosis KW - Breast Neoplasms -- Radiography KW - Diagnosis, Computer Assisted -- Methods KW - Female KW - Information Science SP - 815 EP - 823 JO - Journal of Biomedical Informatics JF - Journal of Biomedical Informatics JA - J BIOMED INFORM VL - 44 IS - 5 CY - Burlington, Massachusetts PB - Academic Press Inc. AB - Development of a computational decision aid for a new medical imaging modality typically is a long and complicated process. It consists of collecting data in the form of images and annotations, development of image processing and pattern recognition algorithms for analysis of the new images and finally testing of the resulting system. Since new imaging modalities are developed more rapidly than ever before, any effort for decreasing the time and cost of this development process could result in maximizing the benefit of the new imaging modality to patients by making the computer aids quickly available to radiologists that interpret the images. In this paper, we make a step in this direction and investigate the possibility of translating the knowledge about the detection problem from one imaging modality to another. Specifically, we present a computer-aided detection (CAD) system for mammographic masses that uses a mutual information-based template matching scheme with intelligently selected templates. We presented principles of template matching with mutual information for mammography before. In this paper, we present an implementation of those principles in a complete computer-aided detection system. The proposed system, through an automatic optimization process, chooses the most useful templates (mammographic regions of interest) using a large database of previously collected and annotated mammograms. Through this process, the knowledge about the task of detecting masses in mammograms is incorporated in the system. Then, we evaluate whether our system developed for screen-film mammograms can be successfully applied not only to other mammograms but also to digital breast tomosynthesis (DBT) reconstructed slices without adding any DBT cases for training. Our rationale is that since mutual information is known to be a robust inter-modality image similarity measure, it has high potential of transferring knowledge between modalities in the context of the mass detection task. Experimental evaluation of the system on mammograms showed competitive performance compared to other mammography CAD systems recently published in the literature. When the system was applied "as-is" to DBT, its performance was notably worse than that for mammograms. However, with a simple additional preprocessing step, the performance of the system reached levels similar to that obtained for mammograms. In conclusion, the presented CAD system not only performed competitively on screen-film mammograms but it also performed robustly on DBT showing that direct transfer of knowledge across breast imaging modalities for mass detection is in fact possible. SN - 1532-0464 AD - Department of Radiology, Duke University Medical Center, 2424 Erwin Rd., Suite 302, Durham, NC 27705, USA AD - Department of Radiology, Duke University Medical Center, 2424 Erwin Rd., Suite 302, Durham, NC 27705, USA. U2 - PMID: 21554985. DO - 10.1016/j.jbi.2011.04.008 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104582599&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104703499 T1 - Palliative Medicine and Decision Science: The Critical Need for a Shared Agenda To Foster Informed Patient Choice in Serious Illness. AU - Bakitas, Marie AU - Kryworuchko, Jennifer AU - Matlock, Dan D. AU - Volandes, Angelo E. Y1 - 2011/10// N1 - Accession Number: 104703499. Language: English. Entry Date: 20111111. Revision Date: 20150711. Publication Type: Journal Article; case study; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Palliative Care/Hospice. Grant Information: National Palliative Care Research Center Junior Career Award (MB), Foundation for Informed. NLM UID: 9808462. KW - Palliative Care KW - Decision Making -- Methods KW - Physician-Patient Relations KW - Collaboration KW - Attitude to Illness KW - Female KW - Middle Age KW - Communication -- Methods KW - Cancer Survivors KW - Breast Neoplasms KW - Chronic Pain KW - Patient Satisfaction KW - Decision Support Techniques -- Utilization KW - Videorecording KW - Funding Source SP - 1109 EP - 1116 JO - Journal of Palliative Medicine JF - Journal of Palliative Medicine JA - J PALLIAT MED VL - 14 IS - 10 CY - New Rochelle, New York PB - Mary Ann Liebert, Inc. AB - Assisting patients and their families in complex decision making is a foundational skill in palliative care; however, palliative care clinicians and scientists have just begun to establish an evidence base for best practice in assisting patients and families in complex decision making. Decision scientists aim to understand and clarify the concepts and techniques of shared decision making (SDM), decision support, and informed patient choice in order to ensure that patient and family perspectives shape their health care experience. Patients with serious illness and their families are faced with myriad complex decisions over the course of illness and as death approaches. If patients lose capacity, then surrogate decision makers are cast into the decision-making role. The fields of palliative care and decision science have grown in parallel. There is much to be gained in advancing the practices of complex decision making in serious illness through increased collaboration. The purpose of this article is to use a case study to highlight the broad range of difficult decisions, issues, and opportunities imposed by a life-limiting illness in order to illustrate how collaboration and a joint research agenda between palliative care and decision science researchers, theorists, and clinicians might guide best practices for patients and their families. SN - 1096-6218 AD - , Lebanon, New Hampshire. AD - , Saskatoon SK, . AD - Denver, Aurora, Colorado. AD - , Boston, Massachusetts. U2 - PMID: 21895453. DO - 10.1089/jpm.2011.0032 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104703499&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104584199 T1 - Facilitating reproductive choices: the impact of health services on the experiences of young women with breast cancer. AU - Lee RJ AU - Wakefield A AU - Foy S AU - Howell SJ AU - Wardley AM AU - Armstrong AC Y1 - 2011/10// N1 - Accession Number: 104584199. Language: English. Entry Date: 20120323. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care; Psychiatry/Psychology. NLM UID: 9214524. KW - Breast Neoplasms -- Psychosocial Factors KW - Health Services KW - Reproduction -- Psychosocial Factors KW - Adult KW - Decision Making KW - Female KW - Fertility KW - Focus Groups KW - Reproduction KW - Risk Taking Behavior KW - Young Adult SP - 1044 EP - 1052 JO - Psycho-Oncology JF - Psycho-Oncology JA - PSYCHO ONCOL VL - 20 IS - 10 CY - Hoboken, New Jersey PB - John Wiley & Sons, Inc. AB - Objective: Chemotherapy and hormone treatments carry significant implications on the fertility of young women with breast cancer. Increasingly, nulliparous women experience fertility dilemmas due to rising survival rates and pregnancy delay. This qualitative study investigated women's responses to being told that treatments affected their fertility and how their interactions with health services impacted on their experiences. Methods: Twenty-four women under 40 years participated in three focus groups using a flexible interview structure. Data were analysed using content analysis and participants subsequently member checked the themes generated. Results: The priority for most women was survival, although women without children were more willing to take risks. Many women felt that pregnancy after breast cancer and methods of egg harvesting carried a significant risk to survival and fears appeared to be increased by conflicting advice from health professionals. Overall, the women felt the cancer, its treatment options and the health service itself had each robbed them of choice. Hence, with hindsight, many said they would have welcomed an open and honest discussion with a fertility expert to maximise their options. Conclusions: Young women with breast cancer face complex decisions regarding their fertility and treatment options. Survival remains the priority for the majority of women. Although there is a paucity of evidence concerning many fertility issues, it is essential that available options and any potential risks are discussed in a coherent, objective fashion. Early referral to specialist fertility services that provide clear, cohesive advice can aid informed decision making. Copyright © 2010 John Wiley & Sons, Ltd. SN - 1057-9249 AD - Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK. U2 - PMID: 20818600. DO - 10.1002/pon.1826 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104584199&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104581951 T1 - How do we achieve informed choice for women considering breast screening? AU - Hersch J AU - Jansen J AU - Irwig L AU - Barratt A AU - Thornton H AU - Howard K AU - McCaffery K Y1 - 2011/09// N1 - Accession Number: 104581951. Language: English. Entry Date: 20120323. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 0322116. KW - Breast Neoplasms -- Diagnosis KW - Decision Making, Ethical KW - Early Detection of Cancer -- Psychosocial Factors KW - Consent -- Psychosocial Factors KW - Patient Education -- Methods KW - Women's Health -- Ethical Issues KW - Decision Making KW - Female KW - Health Education KW - Attitude to Health KW - Patient Education -- Ethical Issues KW - Qualitative Studies SP - 144 EP - 146 JO - Preventive Medicine JF - Preventive Medicine JA - PREV MED VL - 53 IS - 3 CY - Burlington, Massachusetts PB - Academic Press Inc. AB - OBJECTIVE: In current medical literature, mammography and other cancer screening programs are subject to controversy because of debate about the magnitude and nature of the benefits and harms. This paper discusses the issues around informed choice for women considering breast screening. METHOD: We discuss qualitative and quantitative studies of women's attitudes to breast screening and informed choice. RESULTS: Women view breast screening as a way of avoiding potential regret, and reassurance from normal results is highly valued. Screening participants acknowledge anxiety about false positives but awareness regarding potential overdetection of indolent breast cancer is minimal, and research is needed to assess how better understanding of screening downsides may affect women's views. In any case, weighing up screening advantages and disadvantages is sensitive to personal preferences. CONCLUSIONS: Communicators have an ethical obligation to make balanced information available to women, which is flexible enough to respond to the level of detail and involvement desired by each individual. Many women want to know more and to participate more actively in screening decisions. Techniques have been developed to present balanced information and support individual decision making in ways that are accessible and empowering for the wider community. Evaluations of breast cancer screening must integrate clinical data with evidence on the perspectives of women themselves. SN - 0091-7435 AD - Screening and Test Evaluation Program, Sydney School of Public Health, Edward Ford Bldg (A27), University of Sydney, NSW 2006, Australia; Centre for Medical Psychology and Evidence-based Decision-making, Transient Bldg (F12), University of Sydney, NSW 2006, Australia. U2 - PMID: 21723312. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104581951&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104572878 T1 - Probability of malignancy for lesions detected on breast MRI: a predictive model incorporating BI-RADS imaging features and patient characteristics. AU - Demartini WB AU - Kurland BF AU - Gutierrez RL AU - Blackmore CC AU - Peacock S AU - Lehman CD AU - Demartini, Wendy B AU - Kurland, Brenda F AU - Gutierrez, Robert L AU - Blackmore, C Craig AU - Peacock, Sue AU - Lehman, Constance D Y1 - 2011/08// N1 - Accession Number: 104572878. Language: English. Entry Date: 20120323. Revision Date: 20171009. Publication Type: journal article; research. Journal Subset: Biomedical; Continental Europe; Double Blind Peer Reviewed; Europe; Peer Reviewed. Special Interest: Diagnostic Imaging. Grant Information: P30 CA015704/CA/NCI NIH HHS/United States. NLM UID: 9114774. KW - Breast Neoplasms -- Diagnosis KW - Magnetic Resonance Imaging -- Methods KW - Adult KW - Aged KW - Aged, 80 and Over KW - Contrast Media -- Diagnostic Use KW - Female KW - Image Interpretation, Computer Assisted KW - Logistic Regression KW - Middle Age KW - Predictive Value of Tests KW - Probability KW - ROC Curve KW - Retrospective Design SP - 1609 EP - 1617 JO - European Radiology JF - European Radiology JA - EUR RADIOL VL - 21 IS - 8 CY - , PB - Springer Science & Business Media B.V. AB - Objectives: To predict the probability of malignancy for MRI-detected breast lesions with a multivariate model incorporating patient and lesion characteristics.Methods: Retrospective review of 2565 breast MR examinations from 1/03-11/06. BI-RADS 3, 4 and 5 lesions initially detected on MRI for new cancer or high-risk screening were included and outcomes determined by imaging, biopsy or tumor registry linkage. Variables were indication for MRI, age, lesion size, BI-RADS lesion type and kinetics. Associations with malignancy were assessed using generalized estimating equations and lesion probabilities of malignancy were calculated.Results: 855 lesions (155 malignant, 700 benign) were included. Strongest associations with malignancy were for kinetics (washout versus persistent; OR 4.2, 95% CI 2.5-7.1) and clinical indication (new cancer versus high-risk screening; OR 3.0, 95% CI 1.7-5.1). Also significant were age > = 50 years, size > = 10 mm and lesion-type mass. The most predictive model (AUC 0.70) incorporated indication, size and kinetics. The highest probability of malignancy (41.1%) was for lesions on MRI for new cancer, > = 10 mm with washout. The lowest (1.2%) was for lesions on high-risk screening, <10 mm with persistent kinetics.Conclusions: A multivariate model shows promise as a decision support tool in predicting malignancy for MRI-detected breast lesions. SN - 0938-7994 AD - Department of Radiology, University of Washington Medical Center, 1959 NE Pacific, Seattle, WA 98195, USA AD - Department of Radiology, University of Washington Medical Center, 1959 NE Pacific, Seattle, WA, 98195, USA, wdemarti@uw.edu. U2 - PMID: 21359910. DO - 10.1007/s00330-011-2094-6 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104572878&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 108235694 T1 - Does use of the adjuvant! Model influence use of adjuvant therapy through better risk communication? AU - Belkora JK AU - Hutton DW AU - Moore DH AU - Siminoff LA Y1 - 2011/07//2011 Jul 1 N1 - Accession Number: 108235694. Language: English. Entry Date: 20111028. Revision Date: 20150712. Publication Type: Journal Article. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Oncologic Care. NLM UID: 101162515. KW - Antineoplastic Agents -- Therapeutic Use KW - Breast Neoplasms -- Drug Therapy KW - Communication KW - Patient Attitudes KW - Physician-Patient Relations KW - Breast Neoplasms -- Diagnosis KW - Breast Neoplasms -- Mortality KW - Chemotherapy, Adjuvant KW - Female KW - Prognosis KW - Risk Factors SP - 707 EP - 712 JO - Journal of the National Comprehensive Cancer Network JF - Journal of the National Comprehensive Cancer Network JA - J NATL COMPR CANCER NETW JNCCN VL - 9 IS - 7 CY - Cold Spring Harbor, New York PB - Harborside Press AB - Adjuvant! is a model that provides recurrence and mortality risk predictions for patients with breast cancer considering adjuvant therapies. Although low-risk patients who saw Adjuvant! chose adjuvant therapy less frequently, whether this was because of educational or other aspects of the decision aid is unknown. The authors explored whether Adjuvant! affects choice of therapy through increased patient knowledge. A subset of data were analyzed from a cluster randomized trial in which oncology practices in 2 major United States cities were randomly assigned to use either Adjuvant! or an informational pamphlet to educate patients. Of 405 patients, 48 were low-risk, with 28 assigned to the decision aid and 20 to the pamphlet. Among the low-risk patients, using frequency tables and Fisher exact tests, the authors explored whether Adjuvant! was associated with more accurate patient estimates of survival; whether accuracy was associated with treatment choice; and whether, after controlling for accuracy, any remaining association was seen between Adjuvant! and treatment choice. Adjuvant! was associated with more accurate estimates of baseline prognosis compared with the pamphlet (57% vs. 25%; P = .04). Patients who had more accurate estimates of baseline prognosis were less likely to choose adjuvant therapy (62% vs. 89%; P = .04). After controlling for accuracy, no statistically significant association was found between the use of Adjuvant! and adjuvant therapy (P = .59 and P = .11 for inaccurate and accurate patients, respectively). Adjuvant! seems to influence patient choice through educational rather than other means of persuasion. However, many patients held inaccurate risk perceptions after viewing Adjuvant!. SN - 1540-1405 AD - From aUniversity of California San Francisco, San Francisco, California; bDepartment of Health Management and Policy, University of Michigan, Ann Arbor, Michigan; cDepartment of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California; and dDepartment of Social and Behavioral Health, Virginia Commonwealth University, Richmond, Virginia. U2 - PMID: 21715722. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=108235694&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104613487 T1 - Selective Application of Routine Preoperative Axillary Ultrasonography Reduces Costs for Invasive Breast Cancers. AU - Turaga, Kiran K. AU - Chau, Alec AU - Eatrides, Jennifer M. AU - Kiluk, John V. AU - Khakpour, Nazanin AU - Laronga, Christine AU - Lee, M. Catherine Y1 - 2011/07// N1 - Accession Number: 104613487. Language: English. Entry Date: 20120109. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Commentary: GEORGE RALPH. Re: Selective Application of Routine Preoperative Axillary Ultrasonography Reduces Costs for Invasive Breast Cancers. (ONCOLOGIST) Aug2011; 16 (8): 1069-1069. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Oncologic Care; Perioperative Care. Grant Information: This study was supported in part by the Don and Erika Wallace Breast Cancer Research Foundation.. NLM UID: 9607837. KW - Preoperative Care KW - Lymph Nodes -- Ultrasonography KW - Axilla -- Ultrasonography KW - Biopsy, Needle KW - Neoplasm Metastasis -- Surgery KW - Breast Neoplasms -- Economics KW - Decision Making, Clinical KW - Education, Continuing (Credit) KW - Patient Selection KW - Human KW - Health Facility Costs KW - Cost Savings KW - Sensitivity and Specificity KW - Confidence Intervals KW - Funding Source SP - 942 EP - 948 JO - Oncologist JF - Oncologist JA - ONCOLOGIST VL - 16 IS - 7 CY - Durham, North Carolina PB - AlphaMed Company, Inc., dba AlphaMed Press AB - Purpose. Preoperative axillary sonography with fine needle aspiration (FNA) in patients with invasive breast cancer identifies patients with nodal metastasis who can be spared further surgery. Indiscriminate use of the diagnostic modality can increase costs and yield inaccurate results. We evaluate the costs associated with the use of highly sensitive axillary ultrasonography in patients with stage ≥T2 tumors. Patients and Methods. We constructed a decision analysis tree using TreeAge Pro 2009 software comparing direct hospital charges between patients with and without routine use of axillary ultrasound. Base case estimates were derived from our institutional data and compared with those derived from the literature. One- and two-way sensitivity analyses were performed to check the validity of our inferences. Results. We found that, for the base case estimate with 35% lymph node positivity in stage ≥T2 tumors and sensitivity of the axillary ultrasound set at 86% with a specificity of 40%, the strategy to perform preoperative axillary ultrasound yielded rollback costs of $15,215, compared with $15,940 for surgery plus sentinel lymph node biopsy (cost difference, $725 per patient favoring axillary ultrasound). On two-way sensitivity analysis, the cost benefit for axillary ultrasound was not seen in patients with a low risk for nodal metastasis. Conclusion. The adoption of routine preoperative axillary sonography with FNA is a lower-cost strategy than conventional strategies in patients with stage ≥T2 invasive breast cancer. SN - 1083-7159 AD - Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA; Comprehensive Breast Program, Department of Women's Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA AD - Division of Breast Imaging, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA AD - University of South Florida College of Medicine, Tampa, Florida, USA AD - Comprehensive Breast Program, Department of Women's Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA; Departments of Oncologic Sciences and Surgery, University of South Florida College of Medicine, Tampa, Florida, USA U2 - PMID: 21572122. DO - 10.1634/theoncologist.2010-0373 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104613487&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104645727 T1 - Entertainment education for breast cancer surgery decisions: A randomized trial among patients with low health literacy. AU - Jibaja-Weiss ML AU - Volk RJ AU - Granchi TS AU - Neff NE AU - Robinson EK AU - Spann SJ AU - Aoki N AU - Friedman LC AU - Beck JR Y1 - 2011/07// N1 - Accession Number: 104645727. Language: English. Entry Date: 20111028. Revision Date: 20150711. Publication Type: Journal Article; research; randomized controlled trial. Journal Subset: Core Nursing; Europe; Health Promotion/Education; Nursing; Peer Reviewed; UK & Ireland. NLM UID: 8406280. KW - Breast Neoplasms -- Surgery KW - Computer Assisted Instruction KW - Consumer Participation -- Methods KW - Consumer Participation -- Psychosocial Factors KW - Decision Support Techniques KW - Information Literacy KW - Patient Education -- Methods KW - Health Literacy KW - Adult KW - Aged KW - Attitude to Health KW - Breast Neoplasms -- Diagnosis KW - Breast Neoplasms -- Psychosocial Factors KW - Educational Status KW - Female KW - Hospitals, Public KW - Human KW - Mastectomy KW - Middle Age KW - Multimedia KW - Prospective Studies KW - Randomized Controlled Trials SP - 41 EP - 48 JO - Patient Education & Counseling JF - Patient Education & Counseling JA - PATIENT EDUC COUNS VL - 84 IS - 1 PB - Elsevier B.V. AB - OBJECTIVE: To evaluate an entertainment-based patient decision aid for early stage breast cancer surgery in low health literacy patients. METHODS: Newly diagnosed female patients with early stage breast cancer from two public hospitals were randomized to receive an entertainment-based decision aid for breast cancer treatment along with usual care (intervention arm) or to receive usual care only (control arm). Pre-decision (baseline), pre-surgery, and 1-year follow-up assessments were conducted. RESULTS: Patients assigned to the intervention arm of the study were more likely than the controls to choose mastectomy rather than breast-conserving surgery; however, they appeared better informed and clearer about their surgical options than women assigned to the control group. No differences in satisfaction with the surgical decision or the decision-making process were observed between the patients who viewed the intervention and those assigned to the control group. CONCLUSIONS: Entertainment education may be a desirable strategy for informing lower health literate women about breast cancer surgery options. PRACTICE IMPLICATIONS: Incorporating patient decision aids, particularly computer-based decision aids, into standard clinical practice remains a challenge; however, patients may be directed to view programs at home or at public locations (e.g., libraries, community centers). SN - 0738-3991 AD - Department of Family and Community Medicine, Baylor College of Medicine, USA. U2 - PMID: 20609546. DO - 10.1016/j.pec.2010.06.009 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104645727&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104645739 T1 - An exploration of patient decision-making for autologous breast reconstructive surgery following a mastectomy. AU - Begum S AU - Grunfeld EA AU - Ho-Asjoe M AU - Farhadi J Y1 - 2011/07// N1 - Accession Number: 104645739. Language: English. Entry Date: 20111028. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Core Nursing; Europe; Health Promotion/Education; Nursing; Peer Reviewed; UK & Ireland. NLM UID: 8406280. KW - Breast Neoplasms -- Psychosocial Factors KW - Breast Neoplasms -- Surgery KW - Decision Making KW - Breast Reconstruction -- Psychosocial Factors KW - Mastectomy -- Psychosocial Factors KW - Adult KW - Female KW - Middle Age KW - Patient Satisfaction KW - Physician-Patient Relations KW - Time Factors SP - 105 EP - 110 JO - Patient Education & Counseling JF - Patient Education & Counseling JA - PATIENT EDUC COUNS VL - 84 IS - 1 PB - Elsevier B.V. AB - OBJECTIVE: The aim of this study was to examine patients' experiences of the decision to undergo breast reconstructive surgery following mastectomy. METHOD: 21 Women, who had undergone reconstruction, took part in a semi-structured qualitative interview, which examined the participants' experience of the decision-making process. The recorded interviews were transcribed verbatim and analyzed using 'framework analysis'. RESULTS: Women who underwent immediate reconstruction spoke of the convenience of undergoing only one operation with regards to juggling work and childcare arrangements. For women who underwent delayed reconstructive surgery the reasons centre on dissatisfaction with wearing prosthesis. Others spoke of no choice, as immediate reconstruction was not offered as an option. However both groups did report similar influential factors and received and used similar informational content and informational sources in order to make their decision. CONCLUSION: The study outlines the different motivations for undergoing immediate or delayed breast reconstruction and highlights that there is not always a choice offered to patients. PRACTICE IMPLICATIONS: Future patients who are considering breast reconstruction should be provided with the relevant information to make a well informed decision and may benefit from different methods of information delivery that could include decision aids such as informational booklets, photographs, and videos. SN - 0738-3991 AD - King's College London, Department of Psychology, Institute of Psychiatry, Guy's Hospital, London, UK. U2 - PMID: 20688457. DO - 10.1016/j.pec.2010.07.004 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104645739&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104806544 T1 - Satisfaction with ovarian carcinoma risk-reduction strategies among women at high risk for breast and ovarian carcinoma. AU - Westin SN AU - Sun CC AU - Lu KH AU - Schmeler KM AU - Soliman PT AU - Lacour RA AU - Johnson KG AU - Daniels MS AU - Arun BK AU - Peterson SK AU - Bodurka DC AU - Westin, Shannon N AU - Sun, Charlotte C AU - Lu, Karen H AU - Schmeler, Kathleen M AU - Soliman, Pamela T AU - Lacour, Robin A AU - Johnson, Kristin G AU - Daniels, Molly S AU - Arun, Banu K Y1 - 2011/06/15/ N1 - Accession Number: 104806544. Language: English. Entry Date: 20110826. Revision Date: 20161117. Publication Type: journal article; research. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Oncologic Care. Grant Information: 5T32CA10164202/CA/NCI NIH HHS/United States. NLM UID: 0374236. KW - Breast Neoplasms -- Prevention and Control KW - Early Detection of Cancer KW - Fallopian Tubes -- Surgery KW - Ovarian Neoplasms -- Prevention and Control KW - Oophorectomy KW - Patient Satisfaction KW - Preventive Health Care -- Methods KW - Behavior KW - Adult KW - Aged KW - Aged, 80 and Over KW - Decision Making KW - Female KW - Middle Age KW - Quality of Life KW - Questionnaires SP - 2659 EP - 2667 JO - Cancer (0008543X) JF - Cancer (0008543X) JA - CANCER VL - 117 IS - 12 CY - Hoboken, New Jersey PB - John Wiley & Sons, Inc. AB - Background: Women who are at high risk for breast and ovarian cancer have 2 major management options to reduce their risk of ovarian cancer: periodic screening (PS) or risk-reducing salpingo-oophorectomy (RRSO). Little is known regarding patient satisfaction levels with risk-reduction strategies. Thus, the authors sought to determine levels of patient satisfaction with PS versus RRSO and to identify factors that may influence satisfaction.Methods: As part of a larger study, women who received testing for the breast cancer genes BRCA1 and BRCA2 were sent a follow-up questionnaire packet to explore issues related to cancer risk reduction. The authors report on the results from a variety of validated instruments, including the Satisfaction With Decision (SWD) scale, focused on the choice between PS and RRSO.Results: In total, 544 surveys were mailed, and 313 responses were received (58%). The overall satisfaction rate among respondents was high. The median SWD score was significantly higher in the RRSO group compared with the PS group (P < .001). BRCA mutation carriers had higher median SWD scores regardless of management type (P = .01). Low satisfaction scores were associated with high levels of uncertainty and the perception that the decision between PS and RRSO was difficult to make (P = .001). Satisfaction was unrelated to demographics, clinical factors, or concerns of cancer risk.Conclusions: In the current study, the majority of women who were at high risk for breast and ovarian cancer were satisfied with their choice of risk-reduction strategy. Difficulty with decision making was associated with lower satisfaction levels. Improved education and support through the decision-making process may enhance overall levels of satisfaction. SN - 0008-543X AD - Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA U2 - PMID: 21656744. DO - 10.1002/cncr.25820 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104806544&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104898508 T1 - Clinicians' concerns about decision support interventions for patients facing breast cancer surgery options: understanding the challenge of implementing shared decision-making. AU - Caldon, Lisa J.M. AU - Collins, Karen A. AU - Reed, Malcolm W. AU - Sivell, Stephanie AU - Austoker, Joan AU - Clements, Alison M. AU - Patnick, Julietta AU - Elwyn, Glyn Y1 - 2011/06// N1 - Accession Number: 104898508. Language: English. Entry Date: 20110713. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Europe; Health Services Administration; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care; Women's Health. Grant Information: The study received financial support from Cancer Research UK.. NLM UID: 9815926. KW - Decision Support Techniques KW - Decision Making, Patient KW - Breast Neoplasms -- Surgery KW - Physician Attitudes KW - Human KW - Semi-Structured Interview KW - United Kingdom KW - Audiorecording KW - Conceptual Framework KW - Physician's Role KW - Consumer Participation KW - Internet KW - Qualitative Studies KW - Information Resources -- Methods KW - Funding Source SP - 133 EP - 146 JO - Health Expectations JF - Health Expectations JA - HEALTH EXPECTATIONS VL - 14 IS - 2 CY - Malden, Massachusetts PB - Wiley-Blackwell AB - There is interest in interventions that provide support for patients facing challenging decisions, such as the choice between mastectomy and breast conservation surgery for breast cancer. However, it is difficult to implement these interventions. One potential source of resistance is the attitudes of clinicians. To examine specialist breast clinicians' opinions about the provision of decision support interventions (DesIs) for patients. As part of the development of a web-based DesI (BresDex), semi-structured interviews were conducted with specialist clinicians [breast surgeons, breast care nurses (BCNs) and oncologists] from four breast units in a UK region, and speciality national opinion leaders. Interviews were recorded, transcribed and analysed using the Framework approach. A majority of the 24 clinicians interviewed did not have a working knowledge of DesIs and were ambivalent or sceptical. Many expressed conflicting opinions: they noted the potential benefits, but at the same time expressed reservations about information overlap, overload and about content that they considered inappropriate. Many wanted access to DesIs to be always under clinical supervision. In particular, they were uncertain as regards how DeSIs could be tailored to individual patients' needs and also accommodate clinical practice variation. BCNs were particularly concerned that DesIs might induce patient anxiety and replace their role. The concept of providing interventions to support patients in decision-making tasks generated concern, defensiveness and scepticism. These attitudes will be a significant barrier. Implementation efforts will need to recognize and address these issues if these interventions are to become embedded in clinical practice. SN - 1369-6513 AD - Clinical Lecturer, Department of Oncology, University of Sheffield, Sheffield, UK AD - Principal Research Fellow, Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK AD - Professor, Department of Oncology, University of Sheffield, Sheffield, UK AD - Research Officer, Clinical Epidemiology Interdisciplinary Research Group, Department of Primary Care and Public Health, Cardiff University, Cardiff, UK AD - Reader, Cancer Research UK Primary Care Education Research Group, Cancer Epidemiology Unit, University of Oxford, Oxford, UK AD - Senior Qualitative Researcher, Cancer Research UK Primary Care Education Research Group, Cancer Epidemiology Unit, University of Oxford, Oxford, UK AD - Director, NHS Cancer Screening Programmes, NHS Breast Screening Programme, Sheffield, UK; Visiting Professor, Cancer Screening Research Unit, Cancer Epidemiology Unit, University of Oxford, Oxford, UK AD - Professor, Clinical Epidemiology Interdisciplinary Research Group, Department of Primary Care and Public Health, Cardiff University, Cardiff, UK U2 - PMID: 21029281. DO - 10.1111/j.1369-7625.2010.00633.x UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104898508&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104905798 T1 - What do older patients with early breast cancer want to know while undergoing adjuvant radiotherapy? AU - Wong, Jennifer Jing-Wen AU - D'Alimonte, Laura AU - Angus, Jan AU - Paszat, Lawrence AU - Soren, Barbara AU - Szumacher, Ewa Y1 - 2011/06// N1 - Accession Number: 104905798. Language: English. Entry Date: 20110916. Revision Date: 20171115. Publication Type: journal article; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Health Promotion/Education; Peer Reviewed; USA. Special Interest: Gerontologic Care; Oncologic Care; Women's Health. NLM UID: 8610343. KW - Breast Neoplasms -- Radiotherapy -- In Old Age KW - Cancer Patients -- Education -- In Old Age KW - Health Knowledge -- In Old Age KW - Information Needs -- In Old Age KW - Patient Education -- In Old Age KW - Radiotherapy, Adjuvant -- In Old Age KW - Aged KW - Aged, 80 and Over KW - Attitude to Illness KW - Breast Neoplasms -- Classification KW - Breast Neoplasms -- Diagnosis KW - Breast Neoplasms -- Psychosocial Factors KW - Breast Neoplasms -- Surgery KW - Cancer Care Facilities KW - Cancer Patients -- Psychosocial Factors KW - Communication KW - Comorbidity KW - Coping KW - Decision Making, Patient KW - Descriptive Statistics KW - Female KW - Focus Groups KW - Human KW - Information Resources KW - Lumpectomy KW - Marital Status KW - Narratives KW - Needs Assessment KW - Ontario KW - Outpatients KW - Patient Satisfaction KW - Patient-Family Relations KW - Physician-Patient Relations KW - Qualitative Studies KW - Questionnaires KW - Support, Psychosocial SP - 254 EP - 261 JO - Journal of Cancer Education JF - Journal of Cancer Education JA - J CANCER EDUC VL - 26 IS - 2 CY - , PB - Springer Science & Business Media B.V. AB - The study aims to investigate the information needs and unique illness experiences of older women with early stage breast cancer. Breast cancer patients have expressed a high need for information to help them cope with their disease and treatment decision making. Satisfying information needs can also improve patient outcomes including perceptions of control, levels of distress, and psychological well-being. Focus groups and one patient interview were conducted investigating the informational needs of patients 70 years or older who were diagnosed with stage I breast cancer. Women identified their experiences and information needs related to diagnosis, participation in treatment decision making, treatment onset, and unexpected life changes. They provided several suggestions to healthcare professionals related to breast cancer treatment. The study's findings increase our understanding of older breast cancer patients' needs and provide a foundation for the development of a decision aid to help patients better understand their treatment options. SN - 0885-8195 AD - Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, Canada AD - Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada AD - Toronto, ON, Canada U2 - PMID: 21221883. DO - 10.1007/s13187-010-0188-5 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104905798&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104905800 T1 - Preoperative patient education for breast reconstruction: a systematic review of the literature. AU - Preminger, Beth Aviva AU - Lemaine, Valerie AU - Sulimanoff, Isabel AU - Pusic, Andrea L. AU - McCarthy, Colleen M. Y1 - 2011/06// N1 - Accession Number: 104905800. Language: English. Entry Date: 20110916. Revision Date: 20171115. Publication Type: journal article; algorithm; research; systematic review; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Health Promotion/Education; Peer Reviewed; USA. Special Interest: Evidence-Based Practice; Oncologic Care; Perioperative Care; Women's Health. NLM UID: 8610343. KW - Breast Reconstruction KW - Preoperative Education KW - Surgical Patients -- Education KW - Teaching Materials KW - Breast Neoplasms -- Surgery KW - CINAHL Database KW - Decision Making, Patient KW - Embase KW - Female KW - Health Knowledge KW - Human KW - Mastectomy KW - Medline KW - Patient Satisfaction KW - Psycinfo KW - Systematic Review SP - 270 EP - 276 JO - Journal of Cancer Education JF - Journal of Cancer Education JA - J CANCER EDUC VL - 26 IS - 2 CY - , PB - Springer Science & Business Media B.V. AB - This study aims to assess the current state of patient educational tools available for the purposes of educating women about postmastectomy breast reconstruction. A systematic review of the English language literature was conducted between the years 1966 and 2009 of all studies pertaining to the use of educational materials for breast reconstruction. MEDLINE, CINAHAL, PsycINFO, EMBASE, SCOPUS, and the Science Citation Index were searched. Only studies that both employed and evaluated a patient educational tool in the setting of postmastectomy reconstruction were selected for review. Qualifying studies were then evaluated with respect to their study design, sample size, and outcome measure evaluated. Each educational tool identified was similarly evaluated with respect to its development process, content, and educational medium. A total of 497 articles were retrieved. Of these, only seven met our inclusion criteria. These publications evaluated a total of seven educational tools. Among them were employed various mediums including written, visual, and audio materials. Detailed review revealed that the development of only one educational program included an educational needs assessment. Only two of the seven studies identified evaluated the efficacy of their educational tool using a randomized controlled trial study design. Outcome measures evaluated varied among the studies identified and included: knowledge gains (n = 4), the 'yes' or 'no' decision to undergo reconstruction (n = 3), satisfaction with decision regarding reconstruction (n = 1), decisional conflict (n = 3), and type of reconstruction (n = 3). This review highlights the need for well-designed, methodologically sound research into patient education regarding breast reconstruction. Such information is invaluable in developing patient education programs and decision aids that aim at patient empowerment. SN - 0885-8195 AD - Plastic and Reconstructive Surgery, Department of Surgery, Columbia University, The Affiliation at Harlem Hospital, 506 Lenox Ave, New York, NY 10037, USA AD - Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA AD - Reference Services, Clinical Medical Librarian, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA AD - Plastic and Reconstructive Surgery, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA U2 - PMID: 21181326. DO - 10.1007/s13187-010-0182-y UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104905800&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104893962 T1 - Development and Evaluation of a Decision Aid for BRCA Carriers with Breast Cancer...[corrected][published erratum appears in J GENETIC COUNS 2013 Jun; 22(3): 406] AU - Culver, Julie AU - MacDonald, Deborah AU - Thornton, Andrea AU - Sand, Sharon AU - Grant, Marcia AU - Bowen, Deborah AU - Burke, Harry AU - Garcia, Nellie AU - Metcalfe, Kelly AU - Weitzel, Jeffrey Y1 - 2011/06// N1 - Accession Number: 104893962. Language: English. Entry Date: 20110630. Revision Date: 20150711. Publication Type: Journal Article; pictorial; research; tables/charts. Journal Subset: Biomedical; Continental Europe; Europe; Peer Reviewed. Special Interest: Oncologic Care; Women's Health. Grant Information: Financial support for this study was provided by a grant from the Susan G. Komen Breast Cancer Foundation (Grant # BCTR0600463) and in part by a General Clinical Research Center grant from NIH (M01 RR00043) and Cancer Center Support Grant (NCI-P20 CA 33572).. NLM UID: 9206865. KW - Breast Neoplasms -- Familial and Genetic KW - Decision Support Techniques KW - Genes, BRCA KW - Genetic Counseling KW - Breast Neoplasms -- Psychosocial Factors KW - Breast Neoplasms -- Surgery KW - California KW - Conceptual Framework KW - Decision Making, Patient KW - Descriptive Statistics KW - Disease Susceptibility KW - Female KW - Focus Groups KW - Funding Source KW - Genetic Screening KW - Human KW - Middle Age KW - Ovarian Neoplasms -- Familial and Genetic KW - Ovarian Neoplasms -- Psychosocial Factors KW - Ovarian Neoplasms -- Surgery KW - Qualitative Studies KW - Thematic Analysis KW - World Wide Web SP - 294 EP - 307 JO - Journal of Genetic Counseling JF - Journal of Genetic Counseling JA - J GENETIC COUNS VL - 20 IS - 3 CY - , PB - Springer Science & Business Media B.V. SN - 1059-7700 AD - Division of Clinical Cancer Genetics, Department of Population Sciences, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road Mod 173 Duarte 91010-3000 USA AD - Division of Behavioral Oncology, Department of Population Sciences, & Division of Psychology, Department of Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte USA AD - Division of Nursing Research and Education, Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte USA AD - Department of Social and Behavioral Sciences, Boston University, Boston USA AD - Department of Medicine, Biochemistry and Molecular Biology, George Washington University School of Medicine, Washington USA AD - Department of Clinical Social Work, Sheri & Les Biller Patient and Family Resource Center, City of Hope Comprehensive Cancer Center, Duarte USA AD - Women's College Research Institute, University of Toronto, Toronto Canada U2 - PMID: 21369831. DO - 10.1007/s10897-011-9350-4 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104893962&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104540749 T1 - US Insurance Program's Experience With a Multigene Assay for Early-Stage Breast Cancer. AU - Hornberger, John AU - Chien, Rebecca AU - Krebs, Katie AU - Hochheiser, Louis Y1 - 2011/05/02/May2011 Supplement N1 - Accession Number: 104540749. Language: English. Entry Date: 20120423. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Supplement Title: May2011 Supplement. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; USA. Special Interest: Oncologic Care; Women's Health. NLM UID: 101261852. KW - Breast Neoplasms -- Familial and Genetic KW - Genotype KW - Strategic Planning KW - Human KW - Insurance, Health KW - United States KW - Recurrence -- Prevention and Control KW - Cost Benefit Analysis KW - Confidence Intervals KW - Relative Risk KW - Female KW - Middle Age KW - Quality of Life KW - Sensitivity and Specificity SP - e38s EP - 45s JO - Journal of Oncology Practice JF - Journal of Oncology Practice JA - J ONCOL PRACT CY - Alexandria, Virginia PB - American Society of Clinical Oncology AB - Purpose: National guidelines recommend a 21-gene recurrence score (RS) to aid in adjuvant treatment decision in patients with estrogen receptor (ER) -positive, lymph node (LN) -negative early-stage breast cancer (ESBC). This study was performed to assess the economic implication of the assay in community practices from the perspective of a US payer. Methods: The study analyzed 952 women with ESBC enrolled with Humana (Louisville, KY) who were tested with the 21-gene RS between June 2006 and June 2010. The proportion of women classified by the assay according to RS risk category, use, and costs of chemotherapy regimens and supportive care, and costs of adverse events were obtained from Humana. We adopted a validated Markov model to compute the cost implications of RS for a representative patient. The probability of risk of recurrence, the chemotherapy benefit, and the decision impact of RS were derived from published studies.Results: Two hundred fifty-five patients within the tested population received adjuvant chemotherapy. Adjuvant chemotherapy was administered to 10% of women at low risk, 36% of women at intermediate risk, and 72% of women at high risk of recurrence. On the basis of a meta-analysis in the reduction of chemotherapy after RS, the model estimated an average test saving of $1,160 per patient. The immediate direct savings for chemotherapy drugs, supportive care, and management of adverse events were $1,885, $2,578, and $472, respectively. Prevention of recurrence through appropriate treatment of patients at high risk resulted in additional savings of $199. Conclusion: The adoption of the 21-gene RS led to targeted management of women with ER-positive, LN-negative ESBC and consequently directed savings to the payer. SN - 1554-7477 DO - 10.1200/JOP.2011.000303 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104540749&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104677787 T1 - US Insurance Program's Experience With a Multigene Assay for Early-Stage Breast Cancer. AU - Hornberger, John AU - Chien, Rebecca AU - Krebs, Katie AU - Hochheiser, Louis Y1 - 2011/05// N1 - Accession Number: 104677787. Language: English. Entry Date: 20110825. Revision Date: 20150711. Publication Type: Journal Article; meta analysis; research; tables/charts. Journal Subset: Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Health Services Administration; Peer Reviewed; USA. Special Interest: Evidence-Based Practice; Oncologic Care; Women's Health. NLM UID: 9613960. KW - Breast Neoplasms -- Familial and Genetic KW - Breast Neoplasms -- Drug Therapy KW - Chemotherapy, Cancer KW - Breast Neoplasms -- Economics KW - Human KW - Female KW - Descriptive Statistics KW - Meta Analysis KW - Quality-Adjusted Life Years KW - Sensitivity and Specificity KW - Middle Age SP - e194 EP - 202 JO - American Journal of Managed Care JF - American Journal of Managed Care JA - AM J MANAGE CARE VL - 17 IS - 5 CY - Plainsboro, New Jersey PB - Intellisphere, LLC AB - Objective: National guidelines recommend a 21-gene recurrence score (RS) to aid in adjuvant treatment decision in patients with estrogen receptor (ER)-positive, lymph node (LN)-negative early-stage breast cancer (ESBC). This study was performed to assess the economic implication of the assay in community practices from the perspective of a US payer. Methods: The study analyzed 952 women with ESBC enrolled with Humana (Louisville, KY) who were tested with the 21-gene RS between June 2006 and June 2010. The proportions of women classified by the assay according to RS risk category, use, costs of chemotherapy regimens and supportive care, and costs of adverse events were obtained from Humana. We adopted a validated Markov model to compute the cost implications of RS for a representative patient. The probability of risk of recurrence, the chemotherapy benefit, and the decision impact of RS were derived from published studies. Results: A total of 255 patients within the tested population received adjuvant chemotherapy. Adjuvant chemotherapy was administered to 10% of women at low risk, 36% of women at intermediate risk, and 72% of women at high risk of recurrence. On the basis of a meta-analysis in the reduction of chemotherapy after RS, the model estimated an average test saving of $1160 per patient. The immediate direct savings for chemotherapy drugs, supportive care, and management of adverse events were $1885, $2578, and $472, respectively. Prevention of recurrence through appropriate treatment of patients at high risk resulted in additional savings of $199. Conclusion: The adoption of the 21-gene RS led to targeted management of women with ER-positive, LN-negative ESBC and consequently directed savings to the payer. SN - 1088-0224 U2 - PMID: 21711071. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104677787&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104890474 T1 - It's Now or Never: Fertility-Related Knowledge, Decision-Making Preferences, and Treatment Intentions in Young Women With Breast Cancer--An Australian Fertility Decision Aid Collaborative Group Study. AU - Peate M AU - Meiser B AU - Friedlander M AU - Zorbas H AU - Rovelli S AU - Sansom-Daly U AU - Sangster J AU - Hadzi-Pavlovic D AU - Hickey M Y1 - 2011/05//5/1/2011 N1 - Accession Number: 104890474. Language: English. Entry Date: 20110708. Revision Date: 20150711. Publication Type: Journal Article. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Oncologic Care. NLM UID: 8309333. KW - Breast Neoplasms -- Psychosocial Factors KW - Decision Making KW - Fertility KW - Attitude to Health KW - Adult KW - Australia KW - Breast Neoplasms -- Drug Therapy KW - Conflict (Psychology) KW - Female KW - Consumer Participation SP - 1670 EP - 1677 JO - Journal of Clinical Oncology JF - Journal of Clinical Oncology JA - J CLIN ONCOL VL - 29 IS - 13 CY - Alexandria, Virginia PB - American Society of Clinical Oncology AB - PURPOSE For many young women with early breast cancer, fertility is a priority. Interventions to retain fertility options generally need to be accessed before chemotherapy, but many women do not receive information regarding these options in a timely fashion. Knowledge about fertility and decisional conflict has not previously been measured in young patients with breast cancer considering future pregnancies. METHODS One hundred eleven young women with early breast cancer who had not yet completed their families were recruited around the time of diagnosis. Knowledge regarding fertility-related information, decisional conflict, and preferences regarding fertility information and decision making was measured. Results From a potential fertility-related knowledge score of 10, the mean was 5.2 (standard deviation = 2.3; range, 0 to 10). Decreased knowledge was associated with increased decisional conflict about pursuing fertility preserving interventions (odds ratio [OR] = 0.57; 95% CI, 0.44 to 0.73; P < .001). Thirty-one percent of women reported that they would consider undertaking in vitro fertilization (IVF) as a method to conserve their fertility, whereas 38% were uncertain. Consideration of IVF was not related to whether subjects were in a committed relationship (OR = 1.20; P = .716) or a definite desire for more children (OR = 1.54; P = .513). CONCLUSION Around diagnosis, many young patients with breast cancer have low levels of knowledge about fertility issues. Further, low knowledge is associated with increased decisional conflict, which is likely to undermine the quality of decision making. These findings suggest that targeted and timely fertility information may reduce decisional conflict and increase informed choice. Neither relationship status nor firm plans regarding future children reliably predict desire to pursue fertility preservation. SN - 0732-183X AD - Psychosocial Research Group, Department of Medical Oncology, Level 3 Dickinson Building, Prince of Wales Hospital, Randwick, NSW, Australia 2031; m.peate@unswalumni.com. U2 - PMID: 21444865. DO - 10.1200/JCO.2010.31.2462 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104890474&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104800752 T1 - Longitudinal Changes in Patient Distress following Interactive Decision Aid Use among BRCA1/2 Carriers: A Randomized Trial. AU - Hooker, Gillian W. AU - Leventhal, Kara-Grace AU - DeMarco, Tiffani AU - Peshkin, Beth N. AU - Finch, Clinton AU - Wahl, Erica AU - Joines, Jessica Rispoli AU - Brown, Karen AU - Valdimarsdottir, Heiddis AU - Schwartz, Marc D. Y1 - 2011/05// N1 - Accession Number: 104800752. Language: English. Entry Date: 20110621. Revision Date: 20150711. Publication Type: Journal Article; clinical trial; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Oncologic Care; Women's Health. Instrumentation: Impact of Events Scale (IES); Brief Symptom Inventory (BSI) (Derogatis et al); Multidimensional Impact of Cancer Risk Assessment Questionnaire (MICRA). Grant Information: This research was supported by National Cancer Institute grant R01 CA1846 and by the Jess and Mildred Fisher Center for Familial Cancer Research.. NLM UID: 8109073. KW - Decision Support Techniques -- Evaluation KW - Breast Neoplasms -- Familial and Genetic KW - Patients -- Psychosocial Factors KW - Stress, Psychological -- Epidemiology KW - Funding Source KW - Human KW - Randomized Controlled Trials KW - Descriptive Statistics KW - P-Value KW - Female KW - Adult KW - Middle Age KW - Aged KW - Data Analysis, Statistical KW - Data Analysis Software KW - Nonexperimental Studies KW - Interviews KW - Counseling KW - Brief Symptom Inventory KW - Scales KW - Impact of Events Scale KW - Questionnaires KW - Bivariate Statistics KW - Analysis of Variance KW - Repeated Measures KW - Linear Regression KW - Chi Square Test SP - 412 EP - 421 JO - Medical Decision Making JF - Medical Decision Making JA - MED DECIS MAKING VL - 31 IS - 3 CY - Thousand Oaks, California PB - Sage Publications Inc. SN - 0272-989X AD - schwartm@georgetown.edu U2 - PMID: 20876346. DO - 10.1177/0272989X10381283 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104800752&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104860711 T1 - Expanding the reach of decision and communication aids in a breast care center: A quality improvement study. AU - Belkora JK AU - Teng A AU - Volz S AU - Loth MK AU - Esserman LJ Y1 - 2011/05// N1 - Accession Number: 104860711. Language: English. Entry Date: 20111007. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Core Nursing; Europe; Health Promotion/Education; Nursing; Peer Reviewed; UK & Ireland. NLM UID: 8406280. KW - Breast Neoplasms -- Diagnosis KW - Communication KW - Decision Support Systems, Clinical -- Equipment and Supplies KW - Physician-Patient Relations KW - Quality of Health Care KW - Female KW - Middle Age KW - Program Development KW - Program Evaluation KW - Qualitative Studies KW - Questionnaires KW - Audiorecording KW - Women's Health SP - 234 EP - 239 JO - Patient Education & Counseling JF - Patient Education & Counseling JA - PATIENT EDUC COUNS VL - 83 IS - 2 PB - Elsevier B.V. AB - OBJECTIVE: One academically based breast cancer clinic implements decision and communication aids as part of routine clinical care. This quality improvement study aimed to expand reach of these supportive materials and services with budget-neutral program changes. METHODS: We used program theory and continuous quality improvement to design changes to our program. We calculated reach as the number of new patient visits for which we administered decision and communication aids. We compared reach before and after the program changes. RESULTS: Program changes included: reassigning program outreach tasks from over-committed to under-utilized personnel; deploying personnel in floating rather than fixed schedules; and creating a waitlist so service delivery was dynamically reallocated from overbooked to underbooked personnel. Before these changes, we reached 208 visitors with decision aids, and 142 visitors with communication aids. Changes were associated with expanded reach, culminating in program year 2008 with the delivery of 936 decision aids and 285 communication aids. CONCLUSIONS: We observed over a fourfold increase in decision aid reach and a twofold increase in communication aid reach. We attribute increases to recent program changes. PRACTICE IMPLICATIONS: This study illustrates how program theory and quality improvement methods can contribute to expanded reach of decision and communication aids. SN - 0738-3991 AD - University of California, San Francisco, USA. U2 - PMID: 20696543. DO - 10.1016/j.pec.2010.07.003 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104860711&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104866191 T1 - Optimisation of breast cancer management in low-resource and middle-resource countries: executive summary of the Breast Health Global Initiative consensus, 2010. AU - Anderson BO AU - Cazap E AU - El Saghir NS AU - Yip CH AU - Khaled HM AU - Otero IV AU - Adebamowo CA AU - Badwe RA AU - Harford JB Y1 - 2011/04// N1 - Accession Number: 104866191. Language: English. Entry Date: 20110617. Revision Date: 20150711. Publication Type: Journal Article. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care. NLM UID: 100957246. KW - Breast Neoplasms -- Therapy KW - Breast Neoplasms -- Diagnosis KW - Breast Neoplasms -- Mortality KW - Decision Making KW - Economic Aspects of Illness KW - Health Care Delivery KW - Developing Countries KW - Early Detection of Cancer KW - Female KW - Patient Advocacy SP - 387 EP - 398 JO - Lancet Oncology JF - Lancet Oncology JA - LANCET ONCOL VL - 12 IS - 4 CY - New York, New York PB - Elsevier B.V. AB - The purpose of the Breast Health Global Initiative (BHGI) 2010 summit was to provide a consensus analysis of breast cancer control issues and implementation strategies for low-income and middle-income countries (LMCs), where advanced stages at presentation and poor diagnostic and treatment capacities contribute to lower breast cancer survival rates than in high-income countries. Health system and patient-related barriers were identified that create common clinical scenarios in which women do not present for diagnosis until their cancer has progressed to locally advanced or metastatic stages. As countries progress to higher economic status, the rate of late presentation is expected to decrease, and diagnostic and treatment resources are expected to improve. Health-care systems in LMCs share many challenges including national or regional data collection, programme infrastructure and capacity (including appropriate equipment and drug acquisitions, and professional training and accreditation), the need for qualitative and quantitative research to support decision making, and strategies to improve patient access and compliance as well as public, health-care professional, and policy-maker awareness that breast cancer is a cost-effective, treatable disease. The biggest challenges identified for low-income countries were little community awareness that breast cancer is treatable, inadequate advanced pathology services for diagnosis and staging, and fragmented treatment options, especially for the administration of radiotherapy and the full range of systemic treatments. The biggest challenges identified for middle-resource countries were the establishment and maintenance of data registries, the coordination of multidisciplinary centres of excellence with broad outreach programmes to provide community access to cancer diagnosis and treatment, and the resource-appropriate prioritisation of breast cancer control programmes within the framework of existing, functional health-care systems. SN - 1470-2045 AD - Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, and University of Washington, Seattle, WA, USA. U2 - PMID: 21463833. DO - 10.1016/S1470-2045(11)70031-6 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104866191&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104836215 T1 - How does a German audience appraise an American decision aid on early stage breast cancer? AU - Albrecht K AU - Simon D AU - Buchholz A AU - Reuter K AU - Frosch D AU - Seebauer L AU - Härter M Y1 - 2011/04// N1 - Accession Number: 104836215. Language: English. Entry Date: 20110513. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Core Nursing; Europe; Health Promotion/Education; Nursing; Peer Reviewed; UK & Ireland. NLM UID: 8406280. KW - Breast Neoplasms -- Diagnosis KW - Culture KW - Decision Making KW - Decision Support Techniques KW - Breast Neoplasms -- Prevention and Control KW - Early Diagnosis KW - Whites KW - Female KW - Focus Groups KW - Germany KW - Human KW - Language KW - Questionnaires KW - Reproducibility of Results KW - United States KW - Videorecording SP - 58 EP - 63 JO - Patient Education & Counseling JF - Patient Education & Counseling JA - PATIENT EDUC COUNS VL - 83 IS - 1 PB - Elsevier B.V. AB - OBJECTIVE: To investigate how a German audience appraises an American video-based decision aid on early stage breast cancer for potential use in Germany. METHODS: A German synchronized voice-over version was produced and subject to different focus groups with patients (n=9), health care providers (n=7) and German health care experts (n=15) using an individual questionnaire-based evaluation and a moderated group discussion. Research questions included a general appraisal of the decision aid and the exploration of adaptation needs for use in Germany. Descriptive statistics were calculated and the qualitative data were analyzed applying an inductive approach to categorize the statements. RESULTS: The general appraisal of the decision aid revealed positive results in all groups, especially with regard to comprehensible presentation of information and integration of patients' testimonials. However, cultural differences between the American decision aid and Germany were debated in all groups. CONCLUSION: Despite a high general interest and positive appraisal of the decision aid, the results of this study suggest that it cannot just be translated and used in another country. PRACTICE IMPLICATIONS: The decision aid needs further cultural adaptation and testing in an implementation study before it can be transferred to Germany. SN - 0738-3991 AD - University Medical Center Freiburg, Department of Psychiatry and Psychotherapy, Section of Clinical Epidemiology and Health Services Research, Germany. U2 - PMID: 20627441. DO - 10.1016/j.pec.2010.04.038 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104836215&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104815390 T1 - Understanding surgery choices for breast cancer: how might the Theory of Planned Behaviour and the Common Sense Model contribute to decision support interventions? AU - Sivell, Stephanie AU - Edwards, Adrian AU - Elwyn, Glyn AU - Manstead, Antony S. R. Y1 - 2011/03/02/Mar2011 Supplement N1 - Accession Number: 104815390. Language: English. Entry Date: 20110411. Revision Date: 20150711. Publication Type: Journal Article; research; systematic review; tables/charts. Supplement Title: Mar2011 Supplement. Journal Subset: Europe; Health Services Administration; Peer Reviewed; UK & Ireland. Special Interest: Evidence-Based Practice. Grant Information: Funds from Cancer Research UK support Stephanie Sivell.. NLM UID: 9815926. KW - Breast Neoplasms -- Surgery KW - Ajzen's Theory of Planned Behavior KW - Models, Theoretical KW - Decision Making, Clinical -- Methods KW - Consumer Participation KW - Decision Support Techniques KW - Conceptual Framework KW - Systematic Review KW - Female KW - Medline KW - CINAHL Database KW - Embase KW - Psycinfo KW - Breast Neoplasms -- Psychosocial Factors KW - Treatment Outcomes KW - Physician Attitudes KW - Patient Attitudes KW - Funding Source SP - 6 EP - 19 JO - Health Expectations JF - Health Expectations JA - HEALTH EXPECTATIONS VL - 14 CY - Malden, Massachusetts PB - Wiley-Blackwell AB - To describe the evidence about factors influencing breast cancer patients' surgery choices and the implications for designing decision support in reference to an extended Theory of Planned Behaviour (TPB) and the Common Sense Model of Illness Representations (CSM). A wide range of factors are known to influence the surgery choices of women diagnosed with early breast cancer facing the choice of mastectomy or breast conservation surgery with radiotherapy. However, research does not always reflect the complexities of decision making and is often atheoretical. A theoretical approach, as provided by the CSM and the TPB, could help to identify and tailor support by focusing on patients' representations of their breast cancer and predicting surgery choices. Literature search and narrative synthesis of data. Twenty-six studies reported women's surgery choices to be influenced by perceived clinical outcomes of surgery, appearance and body image, treatment concerns, involvement in decision making and preferences of clinicians. These factors can be mapped onto the key constructs of both the TPB and CSM and used to inform the design and development of decision support interventions to ensure accurate information is provided in areas most important to patients. The TPB and CSM have the potential to inform the design of decision support for breast cancer patients, with accurate and clear information that avoids leading patients to make decisions they may come to regret. Further research is needed examining how the components of the extended TPB and CSM account for patients' surgery choices. SN - 1369-6513 AD - Research Officer AD - Professor in General Practice AD - Professor of Primary Care Medicine, Department of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, Wales, UK AD - Professor of Psychology, School of Psychology, Cardiff University, Cardiff, Wales, UK U2 - PMID: 20579123. DO - 10.1111/j.1369-7625.2009.00558.x UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104815390&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104815385 T1 - What does it take to have sustained use of decision aids? A programme evaluation for the Breast Cancer Initiative. AU - Feibelmann, Sandra AU - Yang, Theresa S. AU - Uzogara, Ekeoma E. AU - Sepucha, Karen Y1 - 2011/03/02/Mar2011 Supplement N1 - Accession Number: 104815385. Language: English. Entry Date: 20110411. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Supplement Title: Mar2011 Supplement. Journal Subset: Europe; Health Services Administration; Peer Reviewed; UK & Ireland. Grant Information: Foundation for Informed Medical Decision Making, 40 Court Street, Suite 300, Boston, MA 02108, USA.. NLM UID: 9815926. KW - Decision Support Techniques -- Utilization KW - Breast Neoplasms KW - Program Evaluation KW - Community Health Services -- Evaluation KW - Attitude of Health Personnel -- Evaluation KW - Cross Sectional Studies KW - Questionnaires KW - Diffusion of Innovation -- Evaluation KW - New England KW - Convenience Sample KW - Cancer Patients KW - Semi-Structured Interview KW - Audiorecording KW - Interview Guides KW - Descriptive Statistics KW - Bivariate Statistics KW - Exploratory Research KW - T-Tests KW - Post Hoc Analysis KW - Fisher's Exact Test KW - Data Analysis Software KW - Human KW - Chi Square Test KW - Funding Source SP - 85 EP - 95 JO - Health Expectations JF - Health Expectations JA - HEALTH EXPECTATIONS VL - 14 CY - Malden, Massachusetts PB - Wiley-Blackwell AB - The Breast Cancer Initiative (BCI) was started in 2002 to disseminate breast cancer decision aids (PtDAs) to providers. We analysed BCI programme data for 195 sites and determined the proportion of sites involved in each of five stages of dissemination and implementation of PtDAs. We conducted cross-sectional mail and telephone surveys of 79 sites with the most interest in implementation. We examined barriers associated with sustained use of the PtDAs. Since 2002 we attempted contact with 195 sites to join the BCI. The majority indicated interest in using PtDAs 172 of 195 (88%), 93 of 195 signed up for the BCI (48%), 57 of 195 reported distributing PtDAs to at least one patient (57%), and 46 of 195 reported sustained use (24%). We analysed data from interviews with 59 of 79 active sites (75% response rate). The majority of providers 49 of 59 (83%) had watched the PtDAs, and 46 of 59 (78%) distributed them to patients. The most common barriers were lack of a reliable way to identify patients before decisions are made (37%), a lack of time to distribute the PtDAs (22%) and having too many educational materials (15%). Sites that indicated a lack of clinician support as a barrier were significantly less likely to have sustained use compared to sites that didn't (33% vs. 74%, P = 0.02). Community breast cancer providers, both physicians and non-physicians, express a high interest in using PtDAs with their patients. About a quarter of sites report sustained use of the PtDAs in routine care. SN - 1369-6513 AD - Health Decision Research Unit, Massachusetts General Hospital (MGH), Boston, MA, USA AD - Graduate School of Medicine, Albany Medical College AD - Psychology Department, University of Michigan AD - Health Decision Research Unit, MGH, Harvard Medical School U2 - PMID: 21323821. DO - 10.1111/j.1369-7625.2010.00640.x UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104815385&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104820325 T1 - Sharing decisions in breast cancer care: Development of the Decision Analysis System for Oncology (DAS-O) to identify shared decision making during treatment consultations. AU - Brown, Richard F. AU - Butow, Phyllis N. AU - Juraskova, Ilona AU - Ribi, Karin AU - Gerber, Daniela AU - Bernhard, Jurg AU - Tattersall, Martin H.N. Y1 - 2011/03// N1 - Accession Number: 104820325. Language: English. Entry Date: 20110420. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Europe; Health Services Administration; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care. Instrumentation: OPTION Scale; Decisional Support Analysis Tool (DSAT); Decision Analysis System for Oncology (DAS-O). Grant Information: The National Breast Cancer Foundation Grant of Australia and a grant of Oncosuisse ⁄ Swiss Cancer League supported this research.. NLM UID: 9815926. KW - Decision Making KW - Consumer Participation KW - Instrument Construction KW - Instrument Validation KW - Breast Neoplasms -- Therapy KW - Physician-Patient Relations KW - Human KW - Communication KW - Scales KW - Qualitative Studies KW - Audiorecording KW - Face Validity KW - Delphi Technique KW - Interrater Reliability KW - Intrarater Reliability KW - Physicians KW - Australia KW - New Zealand KW - Switzerland KW - Germany KW - Austria KW - Questionnaires KW - Data Analysis Software KW - Kappa Statistic KW - Concurrent Validity KW - Funding Source SP - 29 EP - 37 JO - Health Expectations JF - Health Expectations JA - HEALTH EXPECTATIONS VL - 14 IS - 1 CY - Malden, Massachusetts PB - Wiley-Blackwell AB - Shared Decision Making (SDM) is widely accepted as the preferred method for reaching treatment decisions in the oncology setting including those about clinical trial participation: however, there is some disagreement between researchers over the components of SDM. Specific standardized coding systems are needed to help overcome this difficulty. The first objective was to describe the development of an oncology specific SDM coding system, the DAS-O. The second objective was to provide reliability and validity data supporting the DAS-O. Consultation data were available from tertiary cancer center out patient oncology clinics in: Australia, New Zealand (ANZ), Switzerland, Germany and Austria (SGA). Patients were women with a confirmed diagnosis of early stage breast cancer. Reliability data were from 18 randomly selected coded transcripts drawn from ANZ and SGA. Concurrent validity data are from 55 (ANZ) consultations. Inter and Intra rater reliability data was evaluated using Kappa correlation statistics and correlation coefficients. Correlation coefficients were used to assess concurrent validity between the DAS-O and two other SDM coding systems, OPTION and DSAT. Inter and Intra rater reliability for the system were high with average Kappas of 0.58 and 0.65 respectively. Correlation coefficients between DAS-O and OPTION was 0.73 and >0.5 for DSAT. We have developed a reliable and valid coding system for identifying and rating the quality of SDM in breast cancer consultations. SN - 1369-6513 AD - Department of Social and Behavioral Health, Virginia Commonwealth University School of Medicine, Richmond, VA, USA AD - Centre for Medical Psychology and Evidence Based Decision Making, School of Psychology, University of Sydney, Camperdown, NSW, Australia AD - International Breast Cancer Study Group, Co-ordinating Center, Bern, Switzerland AD - International Breast Cancer Study Group, Co-ordinating Center, Bern, Switzerland; Inselspital, Bern University Hospital, Bern, Switzerland AD - Centre for Medical Psychology and Evidence Based Decision Making, School of Psychology, University of Sydney, Camperdown, NSW, Australia; Department of Cancer Medicine, School of Medicine, University of Sydney, Camperdown, NSW, Australia U2 - PMID: 20629766. DO - 10.1111/j.1369-7625.2010.00613.x UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104820325&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104820318 T1 - Communicating uncertainty can lead to less decision satisfaction: a necessary cost of involving patients in shared decision making? AU - Politi, Mary C. AU - Clark, Melissa A. AU - Ombao, Hernando AU - Dizon, Don AU - Elwyn, Glyn Y1 - 2011/03// N1 - Accession Number: 104820318. Language: English. Entry Date: 20110420. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Europe; Health Services Administration; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care. Instrumentation: OPTION Scale; Physicians' Reaction to Uncertainty Scale; Subjective Numeracy Scale. Grant Information: Support for this research was provided by the National Cancer Institute 2 R25 CA087972-06A2 to The Miriam Hospital.. NLM UID: 9815926. KW - Communication KW - Decision Making, Patient KW - Physician-Patient Relations KW - Consumer Participation KW - Human KW - Female KW - Scales KW - Descriptive Statistics KW - Uncertainty KW - Rhode Island KW - Breast Neoplasms -- Psychosocial Factors KW - Questionnaires KW - Record Review KW - Physician Attitudes KW - Maximum Likelihood KW - Data Analysis Software KW - Adult KW - Middle Age KW - Aged KW - Aged, 80 and Over KW - Male KW - Funding Source SP - 84 EP - 91 JO - Health Expectations JF - Health Expectations JA - HEALTH EXPECTATIONS VL - 14 IS - 1 CY - Malden, Massachusetts PB - Wiley-Blackwell AB - Given the large number of interventions of uncertain effectiveness, research on communicating uncertainty is needed to examine its impact on patients' health decisions. To examine physicians' communication of uncertainty and its impact on patients' decisions and decision satisfaction. Participants included female patients seen in a breast health centre whose physicians were discussing a decision with them, with no clear 'best' choice based on outcome evidence. Decision communication was measured using the OPTION scale, a measure of the degree to which physicians involve patients in a decision-making process. One-to-two weeks after the discussion, patients reported their satisfaction with the decision-making process and their decision. Decisions were verified in medical charts with patient consent. Seventy-five women agreed to participate (94% response rate). The mean translated score of the OPTION scale was 68.0 (SD 18.3), but only 33.2 (SD 19.1) for the uncertainty items. Among cancer patients, communicating uncertainty was negatively related to decision satisfaction ( P < 0.002), and there was an interaction between patient involvement in decisions and communicating uncertainty in relation to patients' decision satisfaction ( P < 0.03). Communicating scientific uncertainty might lead to less decision satisfaction among women facing cancer treatment decisions; this could be a natural outcome of the decision making process. Involving patients in decisions might help them tolerate uncertainty. Future studies should consider assessing other outcomes (e.g. knowledge, physician support) of the decision making process. There may be trade-offs between acknowledging uncertainty and immediate decision satisfaction. SN - 1369-6513 AD - Assistant Professor, Department of Surgery, Washington University School of Medicine AD - Associate Professor, Department of Community Health, Alpert Medical School of Brown University AD - Associate Professor, Department of Community Health, Center for Statistical Sciences, Alpert Medical School of Brown University AD - Associate Professor, Department of Obstetrics & Gynecology, Alpert Medical School of Brown University and Program in Women's Oncology, Women and Infants Hospital of RI AD - Distinguished Research Professor, Department of Primary Care and Public Health, Cardiff University, School of Medicine, Wales, UK U2 - PMID: 20860780. DO - 10.1111/j.1369-7625.2010.00626.x UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104820318&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104851778 T1 - Report available on clinical decision support tool to assess patients' risk for deleterious BRCA mutations. Y1 - 2011/02// N1 - Accession Number: 104851778. Language: English. Entry Date: 20110401. Revision Date: 20150711. Publication Type: Journal Article. Journal Subset: Biomedical; USA. Special Interest: Oncologic Care; Women's Health. NLM UID: 9102229. KW - Breast Neoplasms -- Familial and Genetic KW - Decision Support Systems, Clinical KW - Female KW - Mutation SP - 25 EP - 25 JO - AHRQ Research Activities JF - AHRQ Research Activities JA - RES ACTIVITIES IS - 366 CY - Rockville, Maryland PB - Agency for Healthcare Research & Quality SN - 1537-0224 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104851778&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104842009 T1 - eXiT*CBR: A framework for case-based medical diagnosis development and experimentation. AU - López B AU - Pous C AU - Gay P AU - Pla A AU - Sanz J AU - Brunet J Y1 - 2011/02// N1 - Accession Number: 104842009. Language: English. Entry Date: 20110708. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Blind Peer Reviewed; Computer/Information Science; Continental Europe; Europe; Expert Peer Reviewed; Peer Reviewed. Special Interest: Informatics. NLM UID: 8915031. KW - Artificial Intelligence KW - Breast Neoplasms -- Diagnosis KW - Decision Support Systems, Clinical KW - Diagnosis, Computer Assisted KW - Medical Informatics -- Methods KW - Algorithms KW - Computer Graphics KW - Data Mining KW - Decision Support Techniques KW - Female KW - Human KW - Knowledge Bases KW - ROC Curve KW - Reproducibility of Results KW - Systems Integration KW - User-Computer Interface SP - 81 EP - 91 JO - Artificial Intelligence in Medicine JF - Artificial Intelligence in Medicine JA - ARTIF INTELL MED VL - 51 IS - 2 PB - Elsevier B.V. SN - 0933-3657 AD - Control Engineering and Intelligent Systems Research Group, Universitat de Girona, Campus Montilivi, edifice P4, 17071 Girona, Spain; Girona Biomedical Research Institute, Av. de França s/n, 17007 Girona, Spain. U2 - PMID: 20971621. DO - 10.1016/j.artmed.2010.09.002 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104842009&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105003443 T1 - Simple rules can improve prognostic accuracy. AU - Schapira L Y1 - 2011/02//2/1/2011 N1 - Accession Number: 105003443. Language: English. Entry Date: 20110325. Revision Date: 20150711. Publication Type: Journal Article; editorial. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Oncologic Care. NLM UID: 8309333. KW - Antineoplastic Agents -- Therapeutic Use KW - Breast Neoplasms -- Drug Therapy KW - Decision Support Techniques KW - Breast Neoplasms -- Mortality KW - Breast Neoplasms KW - Prognosis KW - Medical Practice, Evidence-Based KW - Female KW - Neoplasm Invasiveness KW - Clinical Trials KW - Risk Assessment KW - Risk Factors KW - Survival Analysis KW - Survival KW - Time Factors KW - Treatment Outcomes SP - 347 EP - 349 JO - Journal of Clinical Oncology JF - Journal of Clinical Oncology JA - J CLIN ONCOL VL - 29 IS - 4 CY - Alexandria, Virginia PB - American Society of Clinical Oncology SN - 0732-183X U2 - PMID: 21189394. DO - 10.1200/JCO.2010.32.9086 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105003443&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104983507 T1 - Socioeconomic factors associated with adjuvant hormone therapy use in older breast cancer survivors. AU - Yen TW AU - Czypinski LK AU - Sparapani RA AU - Guo C AU - Laud PW AU - Pezzin LE AU - Nattinger AB AU - Yen, Tina W F AU - Czypinski, Linda K AU - Sparapani, Rodney A AU - Guo, Changbin AU - Laud, Purushottam W AU - Pezzin, Liliana E AU - Nattinger, Ann B Y1 - 2011/01/15/ N1 - Accession Number: 104983507. Language: English. Entry Date: 20110401. Revision Date: 20161125. Publication Type: journal article. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Oncologic Care. Grant Information: K07 CA125586/CA/NCI NIH HHS/United States. NLM UID: 0374236. KW - Aromatase Inhibitors -- Therapeutic Use KW - Breast Neoplasms -- Drug Therapy KW - Socioeconomic Factors KW - Survivors KW - Tamoxifen -- Therapeutic Use KW - Aged KW - Aged, 80 and Over KW - Chemotherapy, Adjuvant KW - Educational Status KW - Female KW - Support, Psychosocial SP - 398 EP - 405 JO - Cancer (0008543X) JF - Cancer (0008543X) JA - CANCER VL - 117 IS - 2 CY - Hoboken, New Jersey PB - John Wiley & Sons, Inc. AB - Background: The authors sought to identify socioeconomic (SES) factors associated with adjuvant hormone therapy (HT) use among a contemporary population of older breast cancer survivors.Methods: Telephone surveys were conducted among women (ages 65-89 years) residing in 4 states (California, Florida, Illinois, and New York) who underwent initial breast cancer surgery in 2003. Demographic, SES, and treatment information was collected.Results: Of 2191 women, 67% received adjuvant HT with either tamoxifen or an aromatase inhibitor (AI); 71% of those women were on an AI. When adjusting for multiple demographic and SES factors, predictors of HT use were better education (high school degree or higher), better informational/emotional support, and younger age (ages 65-79 years). Race/ethnicity, income, and insurance coverage for medication costs were not associated with receiving HT. For those on HT, when adjusting for all other factors, women were more likely to receive an AI if they had insurance coverage for some or all medication costs, if they were wealthier, if they had better informational/emotional support, and if they were younger (ages 65-69 years).Conclusions: The majority of older women in this population-based cohort received adjuvant HT, and the adoption of AIs was early. The results indicted that providers should be aware that a woman's education level and support system influence her decision to take HT. Given the high cost of AIs, their benefits in postmenopausal women with hormone receptor-positive breast cancer, and the current finding that women with no insurance coverage for medication costs were significantly less likely to receive an AI, we recommend that policymakers address this issue. SN - 0008-543X AD - Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA AD - Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin; Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, Wisconsin. tyen@mcw.edu. U2 - PMID: 20824718. DO - 10.1002/cncr.25412 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104983507&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105000183 T1 - Behavioral and psychosocial effects of rapid genetic counseling and testing in newly diagnosed breast cancer patients: design of a multicenter randomized clinical trial. AU - Wevers, Marijke R AU - Ausems, Margreet Gem AU - Verhoef, Senno AU - Bleiker, Eveline Ma AU - Hahn, Daniela Ee AU - Hogervorst, Frans Bl AU - van der Luijt, Rob B AU - Valdimarsdottir, Heiddis B AU - van Hillegersberg, Richard AU - Rutgers, Emiel Jth AU - Aaronson, Neil K AU - Ausems, Margreet G E M AU - Bleiker, Eveline M A AU - Hahn, Daniela E E AU - Hogervorst, Frans B L AU - Rutgers, Emiel J T H Y1 - 2011/01// N1 - Accession Number: 105000183. Language: English. Entry Date: 20120831. Revision Date: 20161222. Publication Type: journal article; research; randomized controlled trial. Journal Subset: Biomedical; Europe; UK & Ireland. Special Interest: Oncologic Care. NLM UID: 100967800. KW - Breast Neoplasms KW - Breast Neoplasms -- Psychosocial Factors KW - Genetic Counseling -- Psychosocial Factors KW - Genetic Screening -- Psychosocial Factors KW - Adult KW - Behavior KW - Breast Neoplasms -- Surgery KW - Human KW - Mastectomy -- Psychosocial Factors KW - Middle Age KW - Mutation KW - Patient Education KW - Prospective Studies KW - Proteins KW - Randomized Controlled Trials SP - 6 EP - 6 JO - BMC Cancer JF - BMC Cancer JA - BMC CANCER VL - 11 IS - 1 PB - BioMed Central AB - Background: It has been estimated that between 5% and 10% of women diagnosed with breast cancer have a hereditary form of the disease, primarily caused by a BRCA1 or BRCA2 gene mutation. Such women have an increased risk of developing a new primary breast and/or ovarian tumor, and may therefore opt for preventive surgery (e.g., bilateral mastectomy, oophorectomy). It is common practice to offer high-risk patients genetic counseling and DNA testing after their primary treatment, with genetic test results being available within 4-6 months. However, some non-commercial laboratories can currently generate test results within 3 to 6 weeks, and thus make it possible to provide rapid genetic counseling and testing (RGCT) prior to primary treatment. The aim of this study is to determine the effect of RGCT on treatment decisions and on psychosocial health.Methods/design: In this randomized controlled trial, 255 newly diagnosed breast cancer patients with at least a 10% risk of carrying a BRCA gene mutation are being recruited from 12 hospitals in the Netherlands. Participants are randomized in a 2:1 ratio to either a RGCT intervention group (the offer of RGCT directly following diagnosis with tests results available before surgical treatment) or to a usual care control group. The primary behavioral outcome is the uptake of direct bilateral mastectomy or delayed prophylactic contralateral mastectomy. Psychosocial outcomes include cancer risk perception, cancer-related worry and distress, health-related quality of life, decisional satisfaction and the perceived need for and use of additional decisional counseling and psychosocial support. Data are collected via medical chart audits and self-report questionnaires administered prior to randomization, and at 6 month and at 12 month follow-up.Discussion: This trial will provide essential information on the impact of RGCT on the choice of primary surgical treatment among women with breast cancer with an increased risk of hereditary cancer. This study will also provide data on the psychosocial consequences of RGCT and of risk-reducing behavior.Trial Registration: The study is registered at the Netherlands Trial Register (NTR1493) and ClinicalTrials.gov (NCT00783822). SN - 1471-2407 AD - Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, PO Box 90203, 1006 BE Amsterdam, The Netherlands. n.aaronson@nki.nl. U2 - PMID: 21219598. DO - 10.1186/1471-2407-11-6 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105000183&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104987214 T1 - Cost-benefit of laparoscopic versus medical ovarian suppression in premenopausal breast cancer. AU - Hagemann AR AU - Zighelboim I AU - Odibo AO AU - Rader JS AU - Mutch DG AU - Powell MA Y1 - 2011/01//Jan/Feb2011 N1 - Accession Number: 104987214. Language: English. Entry Date: 20110124. Revision Date: 20150711. Publication Type: Journal Article; letter; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Peer Reviewed; USA. Special Interest: Oncologic Care; Women's Health. NLM UID: 9505539. KW - Breast Neoplasms -- Therapy KW - Decision Trees -- Utilization KW - Laparoscopy -- Economics KW - Human KW - Female KW - Adult KW - Descriptive Statistics KW - Confidence Intervals KW - Quality-Adjusted Life Years KW - Data Analysis, Statistical KW - Data Analysis Software SP - 103 EP - 105 JO - Breast Journal JF - Breast Journal JA - BREAST J VL - 17 IS - 1 CY - Malden, Massachusetts PB - Wiley-Blackwell SN - 1075-122X AD - Division of Gynecologic Oncology and Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri U2 - PMID: 21155918. DO - 10.1111/j.1524-4741.2010.01017.x UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104987214&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104987230 T1 - Development and pilot testing of a fertility decision aid for young women diagnosed with early breast cancer. AU - Peate M AU - Meiser B AU - Friedlander M AU - Saunders C AU - Martinello R AU - Wakefield CE AU - Hickey M Y1 - 2011/01//Jan/Feb2011 N1 - Accession Number: 104987230. Language: English. Entry Date: 20110124. Revision Date: 20150711. Publication Type: Journal Article; diagnostic images; letter; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Peer Reviewed; USA. Special Interest: Oncologic Care; Women's Health. NLM UID: 9505539. KW - Breast Neoplasms -- Diagnosis KW - Decision Making, Patient KW - Fertility KW - Information Needs KW - Human KW - Female KW - Adult KW - New South Wales KW - Descriptive Statistics SP - 112 EP - 114 JO - Breast Journal JF - Breast Journal JA - BREAST J VL - 17 IS - 1 CY - Malden, Massachusetts PB - Wiley-Blackwell SN - 1075-122X AD - Department of Medical Oncology, Prince of Wales Hospital, NSW, AustraliaPrince of Wales Clinical School, University of NSW, Australia U2 - PMID: 21129095. DO - 10.1111/j.1524-4741.2010.01033.x UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104987230&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104820236 T1 - How and For Whom Are Decision Aids Effective? Long-Term Psychological Outcome of a Randomized Controlled Trial in Women With Newly Diagnosed Breast Cancer. AU - Vodermaier, Andrea AU - Caspari, Cornelia AU - Wang, Lisa AU - Koehm, Janna AU - Ditsch, Nina AU - Untch, Michael Y1 - 2011/01// N1 - Accession Number: 104820236. Language: English. Entry Date: 20110308. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts; randomized controlled trial. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Oncologic Care; Psychiatry/Psychology; Women's Health. Instrumentation: Decisional Conflict Scale (DCS) (O'Connor); Hospital Anxiety and Depression Scale (HADS) [German]; Body Image Scale [German]; Functional Assessment of Cancer Therapy (FACT) [German]; Freiburg Questionnaire of Coping with Illness (Muthny). NLM UID: 8211523. KW - Decision Support Techniques KW - Cancer Patients -- Psychosocial Factors KW - Decision Making, Patient KW - Breast Neoplasms -- Therapy KW - Breast Neoplasms -- Surgery KW - Randomized Controlled Trials KW - Human KW - Female KW - Breast Neoplasms -- Psychosocial Factors KW - Locus of Control KW - Coping KW - Depression KW - Prospective Studies KW - Conflict (Psychology) KW - Summated Rating Scaling KW - Descriptive Statistics KW - Data Analysis Software KW - T-Tests KW - Fisher's Exact Test KW - Middle Age KW - Aged KW - Adult KW - Questionnaires KW - Scales KW - Psychological Tests SP - 12 EP - 19 JO - Health Psychology JF - Health Psychology JA - HEALTH PSYCHOL VL - 30 IS - 1 CY - Washington, District of Columbia PB - American Psychological Association AB - Objective: The current study evaluates the long-term psychological impact of a decision aid intervention for surgical and systemic treatment in women with newly diagnosed breast cancer from a previous reported randomized, controlled trial (Vodermaier et al., 2009). Methods: Patients (n = 111) were randomized into usual care, or a 20-min decision aid intervention plus an information brochure prior to consultation planning with the senior physician. The retention rate at 1 year was 88%. Results: Linear mixed model analyses demonstrated that the intervention group experienced less decisional conflict (p = .047;d = .19), which was driven by perceptions of a more effective choice (p = .029;d= .20) overtime. Subgroup analyses revealed that patients in the intervention group who participated in chemotherapy decision making showed better long-term body image outcomes (p = .009; d = .44), which were mediated by reduced depressive coping (p = .049). No effects emerged for anxiety and depressive symptoms, or for quality of life. Internal health locus of control moderated group effects on 'uncertainty with the decision' (p = .003). Conclusions: The study results provide novel evidence on the role of individual differences and the mechanisms behind decision aid effectiveness, and demonstrate the long-term impact of decision aid interventions on some indices of well-being. SN - 0278-6133 U2 - PMID: 21299290. DO - 10.1037/a0021648 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104820236&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104889805 T1 - An economic evaluation of positron emission tomography (PET) and positron emission tomography/computed tomography (PET/CT) for the diagnosis of breast cancer recurrence. AU - Auguste P AU - Barton P AU - Hyde C AU - Roberts T Y1 - 2011/01// N1 - Accession Number: 104889805. Language: English. Entry Date: 20111014. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. Special Interest: Evidence-Based Practice. NLM UID: 9706284. KW - Breast Neoplasms -- Radiography KW - Neoplasm Recurrence, Local -- Radiography KW - Tomography, Emission-Computed -- Economics KW - Tomography, X-Ray Computed -- Economics KW - Breast Neoplasms -- Pathology KW - Cost Benefit Analysis KW - Decision Trees KW - Female KW - Models, Statistical KW - Quality-Adjusted Life Years SP - 1 EP - 54 JO - Health Technology Assessment JF - Health Technology Assessment JA - HEALTH TECHNOL ASSESS VL - 15 IS - 24 PB - NIHR Journals Library AB - OBJECTIVES: To review the published economic studies that have evaluated positron emission tomography/computed tomography (PET/CT) in the treatment of recurrent breast cancer, and to develop and carry out a model-based economic evaluation to investigate the relative cost-effectiveness of PET/CT to detect breast cancer recurrence compared with conventional work-up. DATA SOURCES: A systematic review of economic and diagnostic evidence for PET/CT in diagnosis of breast cancer recurrence. The original databases searched include MEDLINE (Ovid) (1950 to week 5 May 2009), EMBASE (Ovid) (1980 to 2009 week 22) and the NHS Economic Evaluation Database. An updated search was conducted for each database from May 2009 to week 4 April 2010. METHODS: A decision tree was developed in TREEAGE software (TreeAge Software Inc., Williamstown, MA, USA). The relevant data on accuracy, sensitivity and specificity of each diagnostic test were linked in the model, to costs and the primary outcome measure, cost per quality-adjusted life-year (QALY). The model estimated the mean cost associated with each diagnostic procedure and assumed that patients entering the model were aged 50-75 years. The results of the cost-effectiveness analysis are presented in terms of the incremental cost-effectiveness ratios (ICERs). RESULTS: The ICER for the strategy of PET compared with conventional work-up was estimated at £29,300 per QALY; the ICER for PET/CT compared with PET was £31,000 per QALY; and the ICER for PET/CT combined with conventional work-up versus PET/CT was £42,100. Clearly, for each additional diagnostic test that is added to PET, the more expensive the package becomes, but also the more effective it becomes in terms of QALYs gained. The probabilistic sensitivity analysis shows that at a willingness-to-pay threshold of £20,000 per QALY, conventional work-up is the preferred option. LIMITATIONS: Only data from indirect comparisons are available from the accuracy review, and there is some uncertainity about whether the data defining the accuracy of PET/CT present its use as a replacement or as an adjunct to conventional work-up. CONCLUSIONS: Based on the current model and given the limitations that are apparent in terms of limited availability of data, the result of the current analysis suggests that the use of PET/CT in the diagnosis of recurrent breast cancer in every woman suspected of having a recurrence is unlikely to be cost-effective given the current willingness-to-pay thresholds that are accepted in the UK by decision-making bodies such as the National Institute for Health and Clinical Excellence. Our modelling suggests that conventional work-up could be the most cost-effective diagnostic strategy given current data. Future studies need to secure robust cost data that can be verified from more than one source for the diagnostic tests involved in PET and PET/CT. Reliable and verifiable data on quality of life associated with this clinical condition are also crucial. FUNDING: The National Institute for Health Research Health Technology Assessment programme. SN - 1366-5278 AD - Health Economics Unit on behalf of West Midlands Health Technology Assessment Collaboration, School of Health and Population Science, University of Birmingham, Birmingham, UK. U2 - PMID: 21524363. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104889805&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104600006 T1 - Predictors of nonsentinel nodal involvement to aid intraoperative decision making in breast cancer patients with positive sentinel lymph nodes. AU - Tan, Ern Yu AU - Ho, Bernard AU - Chen, Juliana J.C. AU - Ho, Pey Woei AU - Teo, Christine AU - Earnest, Arul AU - Chan, Patrick M.Y. Y1 - 2011/01// N1 - Accession Number: 104600006. Language: English. Entry Date: 20120120. Revision Date: 20171129. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Oncologic Care; Perioperative Care; Women's Health. NLM UID: 101567026. KW - Breast Neoplasms -- Surgery KW - Decision Making KW - Lymph Nodes KW - Neoplasm Metastasis KW - Adult KW - Aged KW - Biopsy KW - Chi Square Test KW - Confidence Intervals KW - Cox Proportional Hazards Model KW - Data Analysis Software KW - Descriptive Statistics KW - Fisher's Exact Test KW - Human KW - Middle Age KW - Odds Ratio KW - Retrospective Design KW - ROC Curve KW - Singapore SP - 1 EP - 7 JO - ISRN Oncology JF - ISRN Oncology JA - ISRN ONCOL CY - London, PB - Hindawi Limited AB - Background. Up to 60% of patients with a positive sentinel lymph node (SLN) have no additional nodal involvement and do not benefit from completion axillary lymph node dissection (ALND). We aim to identify factors predicting for non-SLN involvement and to validate the MSKCC nomogram and Tenon score in our population. Methods. Retrospective review was performed of 110 consecutive patients with positive SLNs who underwent ALND over an 8-year period. Results. Fifty patients (45%) had non-SLN involvement. Non-SLN involvement correlated positively with the number of positive SLNs (P = 0.04), macrometastasis (P = 0.01), and inversely with the total number of SLNs harvested (P = 0.03). The MSKCC nomogram and Tenon score both failed to perform as previously reported. Conclusions. The MSKCC nomogram and Tenon score have limited value in our practice. Instead, we identified three independent predictors, which are more relevant in guiding the intraoperative decision for ALND. SN - 2090-5661 AD - Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433 AD - Department of Pathology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433 AD - Centre for Quantitative Medicine, Duke-NUS Graduate Medical School Singapore, 8 College Road, Singapore 169857 U2 - PMID: 22091423. DO - 2011/539503 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104600006&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104969715 T1 - Assessing the impact of user-centered research on a clinical trial eHealth tool via counterbalanced research design. AU - Atkinson NL AU - Massett HA AU - Mylks C AU - McCormack LA AU - Kish-Doto J AU - Hesse BW AU - Wang MQ Y1 - 2011/01// N1 - Accession Number: 104969715. Language: English. Entry Date: 20110513. Revision Date: 20150711. Publication Type: Journal Article; research; randomized controlled trial. Journal Subset: Blind Peer Reviewed; Computer/Information Science; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Informatics. NLM UID: 9430800. KW - Breast Neoplasms -- Therapy KW - Clinical Trials KW - Consumer Health Information KW - Internet KW - Patient Satisfaction KW - Patient Selection KW - Adult KW - Aged KW - Female KW - Health Services Research -- Methods KW - Human KW - Middle Age KW - Program Development KW - Randomized Controlled Trials KW - Single-Blind Studies KW - United States KW - User-Computer Interface SP - 24 EP - 31 JO - Journal of the American Medical Informatics Association JF - Journal of the American Medical Informatics Association JA - J AM MED INFORM ASSOC VL - 18 IS - 1 PB - Oxford University Press / USA AB - Objective Informatics applications have the potential to improve participation in clinical trials, but their design must be based on user-centered research. This research used a fully counterbalanced experimental design to investigate the effect of changes made to the original version of a website, http://BreastCancerTrials.org/, and confirm that the revised version addressed and reinforced patients' needs and expectations. Design Participants included women who had received a breast cancer diagnosis within the last 5years (N=77). They were randomized into two groups: one group used and reviewed the original version first followed by the redesigned version, and the other group used and reviewed them in reverse order. Measurements The study used both quantitative and qualitative measures. During use, participants' click paths and general reactions were observed. After use, participants were asked to answer survey items and open-ended questions to indicate their reactions and which version they preferred and met their needs and expectations better. Results Overall, the revised version of the site was preferred and perceived to be clearer, easier to navigate, more trustworthy and credible, and more private and safe overall. However, users who viewed the original version last had similar attitudes toward both versions. Conclusion By applying research findings to the redesign of a website for clinical trial searching, it was possible to re-engineer the interface to better support patients' decisions to participate in clinical trials. The mechanisms of action in this case appeared to revolve around creating an environment that supported a sense of personal control and decisional autonomy. SN - 1067-5027 AD - Department of Public and Community Health, University of Maryland, College Park, Maryland, USA. U2 - PMID: 21169619. DO - 10.1136/jamia.2010.006122 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104969715&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104969923 T1 - Knowledge of genomic testing among early-stage breast cancer patients. AU - Richman AR AU - Tzeng JP AU - Carey LA AU - Retèl VP AU - Brewer NT Y1 - 2011/01// N1 - Accession Number: 104969923. Language: English. Entry Date: 20110325. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care; Psychiatry/Psychology. NLM UID: 9214524. KW - Breast Neoplasms KW - Decision Making KW - Genetic Screening KW - Attitude to Health KW - Neoplasm Recurrence, Local KW - Adult KW - Aged KW - Aged, 80 and Over KW - Antineoplastic Agents -- Therapeutic Use KW - Breast Neoplasms -- Drug Therapy KW - Chemotherapy, Adjuvant KW - Cross Sectional Studies KW - Female KW - Disease Susceptibility KW - Genomics KW - Human KW - Middle Age KW - Neoplasm Recurrence, Local -- Drug Therapy KW - Neoplasm Staging KW - Recurrence KW - Relative Risk SP - 28 EP - 35 JO - Psycho-Oncology JF - Psycho-Oncology JA - PSYCHO ONCOL VL - 20 IS - 1 CY - Hoboken, New Jersey PB - John Wiley & Sons, Inc. AB - Background: Genomic recurrence risk test results now inform clinical decisions about adjuvant treatment for women with early-stage breast cancer. We sought to understand patients' knowledge of these tests and correlates of their knowledge.Methods: Participants in this cross-sectional study were 78 women, treated for early-stage, estrogen receptor-positive breast cancer with 0-3 positive lymph nodes, whose medical records indicated they received Oncotype DX testing earlier. We mailed a questionnaire that assessed knowledge of genomic recurrence risk testing (13 item scale, alpha=0.83) and reviewed medical charts of consenting patients.Results: Knowledge about genomic recurrence risk testing was low (mean knowledge score=67%, SD=0.23). Low knowledge scores were more commonly due to responses of 'don't know' than incorrect answers. Most women (91%) clearly understood that test results can aid decisions about chemotherapy, and few (22%) understood that the test's estimate of the chance of metastasis assumes the patient is receiving hormone therapy. Higher knowledge about genomic recurrence risk testing was associated with higher education, reading ability, and numeracy. Knowledge was higher among women who recalled receiving both verbal and printed information about the test and among women who had active roles in deciding about their treatments. Higher knowledge was also associated with having fewer concerns about genomic testing.Discussion: Among early-stage breast cancer patients who received Oncotype DX, we found low knowledge about many aspects of genomic recurrence risk testing. Research is needed to understand testing information provided to patients and best practices for patient education. Copyright © 2010 John Wiley & Sons, Ltd. SN - 1057-9249 AD - University of North Carolina, Gillings School of Global Public Health, Chapel Hill, NC, USA. U2 - PMID: 20200857. DO - 10.1002/pon.1699 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104969923&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104957274 T1 - Surgical considerations in early-stage breast cancer: lessons learned and future directions. AU - Sabel MS Y1 - 2011/01// N1 - Accession Number: 104957274. Language: English. Entry Date: 20110113. Revision Date: 20150711. Publication Type: Journal Article; review. Journal Subset: Biomedical; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Oncologic Care. NLM UID: 9202882. KW - Breast Neoplasms -- Surgery KW - Physician's Role KW - Neoplasm Recurrence, Local -- Prevention and Control KW - Lumpectomy KW - Neoplasm Staging KW - Breast Neoplasms -- Classification KW - Patient Selection KW - Breast Reconstruction KW - Antineoplastic Agents -- Therapeutic Use KW - Neoadjuvant Therapy KW - Breast Neoplasms -- Drug Therapy KW - Surgical Margin KW - Reoperation KW - Specimen Handling KW - Frozen Sections KW - Intraoperative Care SP - 10 EP - 19 JO - Seminars in Radiation Oncology JF - Seminars in Radiation Oncology JA - SEMIN RADIAT ONCOL VL - 21 IS - 1 CY - Philadelphia, Pennsylvania PB - W B Saunders AB - Emerging evidence regarding the relationship between local failure and outcome in breast cancer has placed increased emphasis on the surgeon''s role in reducing local recurrence after breast-conserving surgery. This includes both improving patient selection and optimizing the procedure. Proper patient selection, selective use of magnetic resonance imaging, and better patient-physician communication including the use of decision aids can optimize both local control and patient satisfaction without unnecessarily increasing the mastectomy rate. Neoadjuvant systemic therapy can increase both the number of patients eligible for breast-conservation surgery as well as the likelihood of success. Adequate surgical margins are crucial and can be achieved without excessive re-excision rates with detailed preoperative planning, consideration of oncoplastic resections. and intraoperative margin analysis. This article reviews several areas in which the surgeon can help ensure the success of breast-conservation therapy. SN - 1053-4296 AD - University of Michigan Comprehensive Cancer Center, Ann Arbor, MI U2 - PMID: 21134649. DO - 10.1016/j.semradonc.2010.08.002 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104957274&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104832580 T1 - Are there any differences between features of proteins expressed in malignant and benign breast cancers? AU - Ebrahimi, Mansour AU - Ebrahimie, Esmaeil AU - Shamabadi, Narges AU - Ebrahimi, Mahdi Y1 - 2010/11//2010 Nov-Dec N1 - Accession Number: 104832580. Language: English. Entry Date: 20110408. Revision Date: 20150819. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Middle East; Peer Reviewed. Special Interest: Oncologic Care; Women's Health. Grant Information: Bioinformatics Research Groups, Green Research Center, Qom University, and School of Agriculture at Shiraz University.. NLM UID: 101235599. KW - Breast Neoplasms -- Physiopathology KW - Proteins -- Physiology KW - Breast Neoplasms -- Epidemiology KW - Chi Square Test KW - Decision Trees KW - Descriptive Statistics KW - Funding Source KW - In Vitro Studies KW - Models, Statistical KW - Models, Theoretical KW - Sequence Analysis SP - 299 EP - 309 JO - Journal of Research in Medical Sciences JF - Journal of Research in Medical Sciences JA - J RES MED SCI VL - 15 IS - 6 PB - Wolters Kluwer India Pvt Ltd AB - BACKGROUND: The most common cancer among women is breast cancer and it has been blamed as the second leading cause of cancer death in women; so far many approaches have been used to analyze and detect benign and malignant forms of cancer and understanding the features involved in proteins expressed by various types of breast cancers is crucial. METHODS: Herein features of proteins expressed in malignant, benign and both cancers were compared using different screening techniques, clustering methods, decision tree models and generalized rule induction (GRI) algorithms to look for patterns of similarity in two benign and malignant breast cancer groups. RESULTS: The findings showed that the N-terminal amino acid was Met and 57 out of 838 proteins' features ranked as important (p > 0.05). The depth of the trees induced by tree induction models varied from 5 (in the Quest model) to 2 (in the C5.0 model) branches. The best performance evaluation found when C&RT model applied and the worst evaluation found when CHAID model applied. No significant difference in the percentage of correctness, performance evaluation, and mean correctness in tree induction algorithms was found when feature selection applied on datasets, but the number of peer groups reduced significantly (p CONCLUSIONS: The frequency of Ile-Ile was the most important protein attributes in all tree and rule induction models. The importance of sequence-based classification and the frequency of Ile-Ile in prediction of malignant and benign breast cancer have been discussed here. SN - 1735-1995 AD - Bioinformatics Research Group, Green Research Center, Qom University, Qom, Iran U2 - PMID: 21526102. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104832580&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104942375 T1 - Learning About a Twist in the Road: Perspectives of At-Risk Relatives Learning of Potential for Cancer. AU - Crotser CB AU - Dickerson SS Y1 - 2010/11// N1 - Accession Number: 104942375. Language: English. Entry Date: 20101209. Revision Date: 20150819. Publication Type: Journal Article; research; tables/charts. Journal Subset: Core Nursing; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Nursing; Peer Reviewed; USA. Special Interest: Oncologic Care. NLM UID: 7809033. KW - Breast Neoplasms -- Familial and Genetic KW - Ovarian Neoplasms -- Familial and Genetic KW - Women -- Psychosocial Factors KW - Family History KW - Genetic Screening KW - Human KW - Adult KW - Female KW - Middle Age KW - Purposive Sample KW - Genes, BRCA KW - Research Subject Recruitment KW - Phenomenological Research KW - Thematic Analysis KW - Communication KW - Attitude -- Evaluation KW - Emotions KW - Support, Psychosocial SP - 723 EP - 733 JO - Oncology Nursing Forum JF - Oncology Nursing Forum JA - ONCOL NURS FORUM VL - 37 IS - 6 CY - Pittsburgh, Pennsylvania PB - Oncology Nursing Society AB - Purpose/Objectives: To describe the experiences of women who accessed the Facing Our Risk of Cancer Empowered (FORCE) Web site after learning of a family BRCA1 or BRCA2 mutation.Research Approach: Interpretive phenomenology based on Heideggerian hermeneutics.Setting: Telephone interviews of women living in the United States who accessed FORCE.Participants: A purposive sample of eight women aged 19-47 years.Methodologic Approach: Team interpretation using Diekelmann, Allen, and Tanner's seven-step process.Main Research Variables: Experience of family communication of BRCA results.Findings: Women described (a) finding out, (b) unexpected feelings, (c) mulling it over, (d) finding support, (e) seeking direction from healthcare professionals, (f) redefining future possibilities, and (g) navigating a twist in the road.Conclusions: Many healthcare professionals are not prepared to address genetic risk. Some women who learned of potential risk experienced turmoil as potential risk for cancer unfolded. They felt isolated and unsupported by healthcare providers. They desired assistance in navigating the healthcare system to protect their future health.Interpretation: Healthcare professionals have important roles in (a) assessing support networks of individuals seeking BRCA testing, (b) providing anticipatory guidance on risk communication, (c) remaining sensitive to the impact of seeing cancer as a future possibility, (d) allowing time for individuals to process such news, (e) assessing the psychosocial impact of news of a family BRCA mutation, and (f) providing referrals for support and health needs. Women desire decision support from healthcare providers. Future research should examine cancer risk communication in diverse groups of women. SN - 0190-535X AD - Roberts Wesleyan College, Rochester, NY U2 - PMID: 21059584. DO - 10.1188/10.ONF.723-733 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104942375&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104931639 T1 - Visualizing and assessing discrimination in the logistic regression model. AU - Royston P AU - Altman DG AU - Royston, Patrick AU - Altman, Douglas G Y1 - 2010/10/30/ N1 - Accession Number: 104931639. Language: English. Entry Date: 20110225. Revision Date: 20160617. Publication Type: journal article; research. Journal Subset: Biomedical; USA. Grant Information: //Cancer Research UK/United Kingdom. NLM UID: 8215016. KW - Data Display KW - Logistic Regression KW - Breast Neoplasms -- Diagnosis KW - Confidence Intervals KW - Coronary Disease -- Mortality KW - Decision Support Techniques KW - Discriminant Analysis KW - Female KW - Human KW - Multivariate Analysis KW - Predictive Value of Tests KW - Prognosis KW - ROC Curve KW - Risk Assessment -- Methods KW - Treatment Outcomes SP - 2508 EP - 2520 JO - Statistics in Medicine JF - Statistics in Medicine JA - STAT MED VL - 29 IS - 24 CY - Hoboken, New Jersey PB - John Wiley & Sons, Inc. AB - Logistic regression models are widely used in medicine for predicting patient outcome (prognosis) and constructing diagnostic tests (diagnosis). Multivariable logistic models yield an (approximately) continuous risk score, a transformation of which gives the estimated event probability for an individual. A key aspect of model performance is discrimination, that is, the model's ability to distinguish between patients who have (or will have) an event of interest and those who do not (or will not). Graphical aids are important in understanding a logistic model. The receiver-operating characteristic (ROC) curve is familiar, but not necessarily easy to interpret. We advocate a simple graphic that provides further insight into discrimination, namely a histogram or dot plot of the risk score in the outcome groups. The most popular performance measure for the logistic model is the c-index, numerically equivalent to the area under the ROC curve. We discuss the comparative merits of the c-index and the (standardized) mean difference in risk score between the outcome groups. The latter statistic, sometimes known generically as the effect size, has been computed in slightly different ways by several different authors, including Glass, Cohen and Hedges. An alternative measure is the overlap between the distributions in the outcome groups, defined as the area under the minimum of the two density functions. The larger the overlap, the weaker the discrimination. Under certain assumptions about the distribution of the risk score, the c-index, effect size and overlap are functionally related. We illustrate the ideas with simulated and real data sets. SN - 0277-6715 AD - MRC Clinical Trials Unit, 222 Euston Road, London NW12DA, UK AD - MRC Clinical Trials Unit, 222 Euston Road, London NW1 2DA, U.K. U2 - PMID: 20641144. DO - 10.1002/sim.3994 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104931639&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105095041 T1 - Application of breast MRI for prediction of lymph node metastases - systematic approach using 17 individual descriptors and a dedicated decision tree. AU - Dietzel M AU - Baltzer PA AU - Vag T AU - Gröschel T AU - Gajda M AU - Camara O AU - Kaiser WA Y1 - 2010/10// N1 - Accession Number: 105095041. Language: English. Entry Date: 20101008. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Blind Peer Reviewed; Continental Europe; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed. Special Interest: Diagnostic Imaging. NLM UID: 8706123. KW - Breast Neoplasms -- Pathology KW - Decision Trees KW - Lymph Nodes -- Pathology KW - Magnetic Resonance Imaging KW - Adult KW - Aged KW - Aged, 80 and Over KW - Female KW - Human KW - Neoplasm Metastasis KW - Middle Age KW - Neoplasm Invasiveness KW - Neoplasm Staging KW - Predictive Value of Tests KW - Prognosis KW - Prospective Studies SP - 885 EP - 894 JO - Acta Radiologica JF - Acta Radiologica JA - ACTA RADIOL VL - 51 IS - 8 PB - Sage Publications, Ltd. SN - 0284-1851 AD - Institute of Diagnostic and Interventional Radiology, Friedrich-Schiller-University Jena, Germany. U2 - PMID: 20735278. DO - 10.3109/02841851.2010.504232 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105095041&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104924010 T1 - Using computer-aided detection in mammography as a decision support. AU - Samulski M AU - Hupse R AU - Boetes C AU - Mus RD AU - den Heeten GJ AU - Karssemeijer N Y1 - 2010/10// N1 - Accession Number: 104924010. Language: English. Entry Date: 20110121. Revision Date: 20170802. Publication Type: Journal Article; research. Journal Subset: Biomedical; Continental Europe; Double Blind Peer Reviewed; Europe; Peer Reviewed. Special Interest: Diagnostic Imaging. NLM UID: 9114774. KW - Breast Neoplasms -- Diagnosis KW - Breast Neoplasms -- Pathology KW - Mammography -- Methods KW - Computers and Computerization KW - Decision Support Techniques KW - Early Detection of Cancer KW - False Positive Results KW - Human KW - Image Processing, Computer Assisted KW - Oncology -- Methods KW - Observer Bias KW - Specialties, Medical -- Methods KW - Sensitivity and Specificity KW - Software KW - Time Factors KW - User-Computer Interface SP - 2323 EP - 2330 JO - European Radiology JF - European Radiology JA - EUR RADIOL VL - 20 IS - 10 CY - , PB - Springer Science & Business Media B.V. SN - 0938-7994 AD - Department of Radiology, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6500 HB, Nijmegen, The Netherlands. m.samulski@rad.umcn.nl U2 - PMID: 20532890. DO - 10.1007/s00330-010-1821-8 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104924010&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104920271 T1 - Semantic Space models for classification of consumer webpages on metadata attributes. AU - Chen G AU - Warren J AU - Riddle P Y1 - 2010/10// N1 - Accession Number: 104920271. Language: English. Entry Date: 20110121. Revision Date: 20150711. Publication Type: Journal Article. Journal Subset: Biomedical; Computer/Information Science; Peer Reviewed; USA. Special Interest: Informatics. NLM UID: 100970413. KW - Consumer Health Information -- Classification KW - Internet -- Classification KW - Natural Language Processing KW - Semantics KW - Algorithms KW - Artificial Intelligence KW - Breast Neoplasms KW - Consumer Health Information -- Methods KW - Resource Databases KW - Decision Trees KW - Female SP - 725 EP - 735 JO - Journal of Biomedical Informatics JF - Journal of Biomedical Informatics JA - J BIOMED INFORM VL - 43 IS - 5 CY - Burlington, Massachusetts PB - Academic Press Inc. SN - 1532-0464 AD - Department of Computer Science, The University of Auckland, New Zealand. U2 - PMID: 20601122. DO - 10.1016/j.jbi.2010.06.005 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104920271&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104920272 T1 - Mining patterns in disease classification forests. AU - Hu H Y1 - 2010/10// N1 - Accession Number: 104920272. Language: English. Entry Date: 20110121. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Computer/Information Science; Peer Reviewed; USA. Special Interest: Informatics. NLM UID: 100970413. KW - Algorithms KW - Bioinformatics -- Methods KW - Data Mining -- Methods KW - Decision Trees KW - Disease -- Classification KW - Breast Neoplasms KW - Cells KW - Cluster Analysis KW - Resource Databases KW - Female KW - Gene Expression Profiling KW - Molecular Structure KW - Human KW - Oligonucleotide Array Sequence Analysis KW - Signal Transduction SP - 820 EP - 827 JO - Journal of Biomedical Informatics JF - Journal of Biomedical Informatics JA - J BIOMED INFORM VL - 43 IS - 5 CY - Burlington, Massachusetts PB - Academic Press Inc. SN - 1532-0464 AD - School of Electrical Engineering and Computer Science, University of Central Florida, Orlando, FL 32816, USA. U2 - PMID: 20601123. DO - 10.1016/j.jbi.2010.06.004 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104920272&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104918290 T1 - Helping women make choices about mammography screening: an online randomized trial of a decision aid for 40-year-old women. AU - Mathieu E AU - Barratt AL AU - McGeechan K AU - Davey HM AU - Howard K AU - Houssami N Y1 - 2010/10// N1 - Accession Number: 104918290. Language: English. Entry Date: 20110114. Revision Date: 20150711. Publication Type: Journal Article; research; randomized controlled trial. Journal Subset: Core Nursing; Europe; Health Promotion/Education; Nursing; Peer Reviewed; UK & Ireland. NLM UID: 8406280. KW - Attitude to Health KW - Decision Support Techniques KW - Health Screening -- Adverse Effects KW - Health Screening -- Psychosocial Factors KW - Mammography -- Adverse Effects KW - Mammography -- Psychosocial Factors KW - Questionnaires KW - Adult KW - Australia KW - Breast Neoplasms -- Prevention and Control KW - Cost Benefit Analysis KW - Female KW - Human KW - Intention KW - Internet KW - Middle Age KW - Randomized Controlled Trials SP - 63 EP - 72 JO - Patient Education & Counseling JF - Patient Education & Counseling JA - PATIENT EDUC COUNS VL - 81 IS - 1 PB - Elsevier B.V. AB - OBJECTIVE: To evaluate the effect of a decision aid (DA) on women's knowledge of the benefits and harms of screening and on their ability to make an informed decision. METHODS: An online randomized controlled trial among 321 women aged 38-45 years was conducted. Participants were randomized to either immediate or delayed access to the online DA which (i) explained the benefits and harms, (ii) included a values clarification exercise and a worksheet to support decision making. The primary outcome, knowledge of benefits and harms of screening, and secondary outcomes, informed choice (composite of knowledge, values and intention), anxiety and acceptability of the DA were measured using online questionnaires. RESULTS: Women in the intervention group were more knowledgeable (mean score out of 10, 7.35 vs 6.27, p<0.001) and were more likely to have made a decision (82% vs 61% p<0.001). Of those who made a decision, women in the intervention group were less likely to start screening now (52% vs 65% p=0.05). There was no significant difference in the proportion of women who made an informed choice (71% intervention group vs 64% control group, p=0.24). The DA was helpful, balanced and clear, and did not make women anxious. CONCLUSIONS: The DA increased knowledge and reduced indecision, without increasing feelings of anxiety. PRACTICE IMPLICATIONS: This decision aid is easy to access online and could be an inexpensive way of supporting women aged 40 who are considering whether to start screening now, or wait until they are 50. The results of this study demonstrate the potential of DAs to help inform women about both the benefits and risks of screening at this age and to support women and clinicians in this decision making process. SN - 0738-3991 AD - Screening and Test Evaluation Program, School of Public Health, The University of Sydney, Australia. erinm@health.usyd.edu.au U2 - PMID: 20149953. DO - 10.1016/j.pec.2010.01.001 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104918290&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105096500 T1 - Interactive decision support for risk management: a qualitative evaluation in cancer genetic counselling sessions. AU - Glasspool DW AU - Oettinger A AU - Braithwaite D AU - Fox J AU - Glasspool, David W AU - Oettinger, Ayelet AU - Braithwaite, Dejana AU - Fox, John Y1 - 2010/09// N1 - Accession Number: 105096500. Language: English. Entry Date: 20101029. Revision Date: 20161116. Publication Type: journal article; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Health Promotion/Education; Peer Reviewed; USA. Special Interest: Informatics; Oncologic Care; Women's Health. Grant Information: //Cancer Research UK/United Kingdom. NLM UID: 8610343. KW - Breast Neoplasms -- Familial and Genetic KW - Decision Support Systems, Clinical -- Evaluation KW - Genetic Counseling KW - Risk Management KW - Adult KW - Attitude to Computers KW - Communication KW - Counselors KW - Disease Susceptibility KW - Evaluation Research KW - Female KW - Funding Source KW - Genes, BRCA KW - Graphical User Interface KW - Human KW - Male KW - Middle Age KW - Patient Simulation KW - Professional-Patient Relations KW - Qualitative Studies KW - Questionnaires KW - Risk Assessment KW - Semi-Structured Interview KW - Software KW - Thematic Analysis KW - United Kingdom SP - 312 EP - 316 JO - Journal of Cancer Education JF - Journal of Cancer Education JA - J CANCER EDUC VL - 25 IS - 3 CY - , PB - Springer Science & Business Media B.V. AB - Genetic counselling for inherited susceptibility to cancer involves communication of a significant amount of information about possible consequences of different interventions. This study explores counsellors' attitudes to computer software designed to aid this process. Eight genetic counsellors used the software with actors playing patients. Clinicians' rating of expected patient satisfaction, content, accuracy, timeliness, format, overall value, ease of use, effect on the patient-provider relationship and effect on clinician's performance were evaluated via qualitative and quantitative analysis of interviews, training tasks and questionnaires. Most counsellors found the software effective. Concerns related to possible impact on consultation dynamics and content. Participants suggested countering these through appropriate new counselling skills and selective use of the computer. The REACT software could provide effective support for genetic risk management counselling. SN - 0885-8195 AD - School of Informatics, University of Edinburgh, Informatics Forum, 10 Crichton Street, Edinburgh EH8 9AB, Scotland AD - School of Informatics, University of Edinburgh, Informatics Forum, 10 Crichton Street, Edinburgh, EH8 9AB, Scotland, dglasspo@inf.ed.ac.uk. U2 - PMID: 20162470. DO - 10.1007/s13187-009-0035-8 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105096500&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104916639 T1 - Verification of a prolonged untreated natural history of breast cancer by the multigene assay. AU - Urbas T AU - Agee N AU - Bouton ME AU - Komenaka IK AU - Urbas, Tadeja AU - Agee, Neal AU - Bouton, Marcia E AU - Komenaka, Ian K Y1 - 2010/09// N1 - Accession Number: 104916639. Language: English. Entry Date: 20110114. Revision Date: 20171114. Publication Type: journal article; case study; research. Journal Subset: Biomedical; USA. Special Interest: Oncologic Care. NLM UID: 9435512. KW - Breast Neoplasms KW - Neoplasms, Ductal, Lobular, and Medullary KW - Decision Support Techniques KW - Proteins KW - RNA -- Analysis KW - Chemotherapy, Adjuvant KW - Disease Progression KW - Female KW - Human KW - Mastectomy KW - Middle Age KW - Paraffin Embedding KW - Receptors, Cell Surface -- Analysis KW - Proteins -- Analysis KW - Recurrence KW - Relative Risk KW - Sentinel Lymph Node Biopsy KW - Body Weights and Measures SP - 624 EP - 627 JO - Medical Oncology JF - Medical Oncology JA - MED ONCOL VL - 27 IS - 3 CY - , PB - Springer Science & Business Media B.V. AB - Individualization of therapy for breast cancer patients has progressed significantly over the last 5 years. A 54-year-old female went over 2 years after her diagnosis of breast cancer with no treatment. The pathologic size, however, indicated that the tumor may not have progressed from diagnosis to operation. Due to the apparent lack of progression over 2 years without treatment, a multigene assay was ordered. The recurrence score was 15, indicating a less than 10% risk of distant recurrence at 10 years. The recurrence score also falls into the "low risk" category. The prolonged natural history of this breast cancer patient suggested an indolent cancer. The "low risk" recurrence score confirmed this history and indicated that adjuvant chemotherapy is probably not beneficial to this patient. SN - 1357-0560 AD - Breast Center, Maricopa Medical Center, Hogan Building, 2nd Floor, 2601 E Roosevelt Street, Phoenix, AZ 85008, USA AD - Breast Center, Maricopa Medical Center, Hogan Building, 2nd Floor, 2601 E Roosevelt Street, Phoenix, AZ, 85008, USA. U2 - PMID: 19548125. DO - 10.1007/s12032-009-9258-0 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104916639&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105047026 T1 - Testing whether decision aids introduce cognitive biases: results of a randomized trial. AU - Ubel PA AU - Smith DM AU - Zikmund-Fisher BJ AU - Derry HA AU - McClure J AU - Stark A AU - Wiese C AU - Greene S AU - Jankovic A AU - Fagerlin A AU - Ubel, Peter A AU - Smith, Dylan M AU - Zikmund-Fisher, Brian J AU - Derry, Holly A AU - McClure, Jennifer AU - Stark, Azadeh AU - Wiese, Cheryl AU - Greene, Sarah AU - Jankovic, Aleksandra AU - Fagerlin, Angela Y1 - 2010/08// N1 - Accession Number: 105047026. Language: English. Entry Date: 20101112. Revision Date: 20161125. Publication Type: journal article; clinical trial; research. Journal Subset: Core Nursing; Europe; Health Promotion/Education; Nursing; Peer Reviewed; UK & Ireland. Grant Information: R01 CA087595-06A1/CA/NCI NIH HHS/United States. NLM UID: 8406280. KW - Breast Neoplasms -- Prevention and Control KW - Readability KW - Decision Support Techniques KW - Selective Estrogen Receptor Modulators -- Therapeutic Use KW - Tamoxifen -- Therapeutic Use KW - Adult KW - Aged KW - Cognition KW - Decision Making KW - Female KW - Attitude to Health KW - Human KW - Middle Age KW - Patient Education -- Methods KW - Risk Assessment KW - Clinical Trials SP - 158 EP - 163 JO - Patient Education & Counseling JF - Patient Education & Counseling JA - PATIENT EDUC COUNS VL - 80 IS - 2 PB - Elsevier B.V. AB - Objective: Women at high risk of breast cancer face a difficult decision whether to take medications like tamoxifen to prevent a first breast cancer diagnosis. Decision aids (DAs) offer a promising method of helping them make this decision. But concern lingers that DAs might introduce cognitive biases.Methods: We recruited 663 women at high risk of breast cancer and presented them with a DA designed to experimentally test potential methods of identifying and reducing cognitive biases that could influence this decision, by varying specific aspects of the DA across participants in a factorial design.Results: Participants were susceptible to a cognitive bias - an order effect - such that those who learned first about the risks of tamoxifen thought more favorably of the drug than women who learned first about the benefits. This order effect was eliminated among women who received additional information about competing health risks.Conclusion: We discovered that the order of risk/benefit information influenced women's perceptions of tamoxifen. This bias was eliminated by providing contextual information about competing health risks.Practice Implications: We have demonstrated the feasibility of using factorial experimental designs to test whether DAs introduce cognitive biases, and whether specific elements of DAs can reduce such biases. SN - 0738-3991 AD - VA Health Services Research and Development Center of Excellence, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA U2 - PMID: 20004545. DO - 10.1016/j.pec.2009.10.021 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105047026&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105061763 T1 - Attitudes toward information about genetic risk for cognitive impairment after cancer chemotherapy: breast cancer survivors compared with healthy controls. AU - Andrykowski MA AU - Burris JL AU - Walsh E AU - Small BJ AU - Jacobsen PB AU - Andrykowski, Michael A AU - Burris, Jessica L AU - Walsh, Erin AU - Small, Brent J AU - Jacobsen, Paul B Y1 - 2010/07/20/ N1 - Accession Number: 105061763. Language: English. Entry Date: 20100820. Revision Date: 20161116. Publication Type: journal article; research. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Oncologic Care. Grant Information: R01 CA082822/CA/NCI NIH HHS/United States. NLM UID: 8309333. KW - Breast Neoplasms -- Drug Therapy KW - Cognition Disorders KW - Disease Susceptibility KW - Aged KW - Attitude KW - Breast Neoplasms KW - Breast Neoplasms -- Psychosocial Factors KW - Decision Making KW - Female KW - Human KW - Middle Age KW - Relative Risk KW - Survivors SP - 3442 EP - 3447 JO - Journal of Clinical Oncology JF - Journal of Clinical Oncology JA - J CLIN ONCOL VL - 28 IS - 21 CY - Alexandria, Virginia PB - American Society of Clinical Oncology AB - Purpose: The trend toward personalized medicine will involve cancer treatment increasingly being tailored to the genetic characteristics of individuals. However, the availability of genetic information does not imply this information is desired or would impact treatment decision making.Methods: One hundred sixty breast cancer survivors (BC group) and 205 healthy controls (HC group) were randomly assigned to respond to two different clinical scenarios varying in genetic-related risk of cognitive impairment (CI; little v very likely) and severity of CI (little v moderate problem) after chemotherapy. Ratings of the importance of being told this genetic information (information importance) and the likelihood this information would affect their decision to receive chemotherapy (information impact) were obtained.Results: Results indicated the importance ascribed to genetic information was greatest when CI likelihood and severity were both high or low (P < .05). Information impact ratings were not sensitive to differences in CI likelihood or severity; the BC group was less likely to indicate genetic information would affect their decision to receive chemotherapy than the HC group (P < .001).Conclusion: Results suggest lessened enthusiasm for genetic information that maintains or increases uncertainty about a specific course of action and highlight the importance of including clinically relevant groups in treatment decision-making research that employs hypothetical scenarios. Although women generally believe it is important to receive genetic information, they might benefit from assistance (eg, decision aid) in the difficult task of integrating information about survival and risk for adverse late effects from cancer treatment. SN - 0732-183X AD - Department of Behavioral Science, University of Kentucky, Lexington, KY 40536-0086, USA AD - Department of Behavioral Science, University of Kentucky, Lexington, KY 40536-0086, USA. mandry@uky.edu U2 - PMID: 20498392. DO - 10.1200/JCO.2009.27.8267 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105061763&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104930903 T1 - Breast cancer prognostic classification in the molecular era: the role of histological grade. AU - Rakha EA AU - Reis-Filho JS AU - Baehner F AU - Dabbs DJ AU - Decker T AU - Eusebi V AU - Fox SB AU - Ichihara S AU - Jacquemier J AU - Lakhani SR AU - Palacios J AU - Richardson AL AU - Schnitt SJ AU - Schmitt FC AU - Tan PH AU - Tse GM AU - Badve S AU - Ellis IO Y1 - 2010/07// N1 - Accession Number: 104930903. Language: English. Entry Date: 20110318. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care. NLM UID: 100927353. KW - Breast Neoplasms KW - Breast Neoplasms -- Pathology KW - Gene Expression Profiling KW - Genes KW - Breast Neoplasms -- Classification KW - Female KW - Human KW - Lymph Nodes -- Pathology KW - Prognosis KW - Severity of Illness Indices KW - Body Weights and Measures SP - 207 EP - 207 JO - Breast Cancer Research JF - Breast Cancer Research JA - BREAST CANCER RES VL - 12 IS - 4 PB - BioMed Central AB - Breast cancer is a heterogeneous disease with varied morphological appearances, molecular features, behavior, and response to therapy. Current routine clinical management of breast cancer relies on the availability of robust clinical and pathological prognostic and predictive factors to support clinical and patient decision making in which potentially suitable treatment options are increasingly available. One of the best-established prognostic factors in breast cancer is histological grade, which represents the morphological assessment of tumor biological characteristics and has been shown to be able to generate important information related to the clinical behavior of breast cancers. Genome-wide microarray-based expression profiling studies have unraveled several characteristics of breast cancer biology and have provided further evidence that the biological features captured by histological grade are important in determining tumor behavior. Also, expression profiling studies have generated clinically useful data that have significantly improved our understanding of the biology of breast cancer, and these studies are undergoing evaluation as improved prognostic and predictive tools in clinical practice. Clinical acceptance of these molecular assays will require them to be more than expensive surrogates of established traditional factors such as histological grade. It is essential that they provide additional prognostic or predictive information above and beyond that offered by current parameters. Here, we present an analysis of the validity of histological grade as a prognostic factor and a consensus view on the significance of histological grade and its role in breast cancer classification and staging systems in this era of emerging clinical use of molecular classifiers. SN - 1465-5411 AD - Department of Histopathology, Nottingham City Hospital NHS Trust, Nottingham University, Nottingham, UK. U2 - PMID: 20804570. DO - 10.1186/bcr2607 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104930903&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105065353 T1 - Breast cancer patients' treatment expectations after exposure to the decision aid program adjuvant online: the influence of numeracy. AU - Lipkus IM AU - Peters E AU - Kimmick G AU - Liotcheva V AU - Marcom P Y1 - 2010/07//Jul/Aug2010 N1 - Accession Number: 105065353. Language: English. Entry Date: 20101001. Revision Date: 20171010. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Oncologic Care; Women's Health. Grant Information: Foundation for Informed Medical Decision Making and Pilot funding from Duke University Medical Center's Breast Cancer SPORE grant. NLM UID: 8109073. KW - Breast Neoplasms -- Drug Therapy KW - Cancer Patients -- Psychosocial Factors KW - Decision Making, Patient KW - Decision Support Techniques -- Evaluation KW - Survival Analysis KW - Analysis of Variance KW - Chemotherapy, Cancer -- Psychosocial Factors KW - Chi Square Test KW - Confidence KW - Confidence Intervals KW - Descriptive Statistics KW - Drug Therapy, Combination -- Psychosocial Factors KW - Female KW - Funding Source KW - Hormone Replacement Therapy -- Psychosocial Factors KW - Human KW - Logistic Regression KW - Middle Age KW - Odds Ratio KW - P-Value KW - Pilot Studies KW - Self Report KW - Spearman's Rank Correlation Coefficient KW - Surveys KW - T-Tests SP - 464 EP - 473 JO - Medical Decision Making JF - Medical Decision Making JA - MED DECIS MAKING VL - 30 IS - 4 CY - Thousand Oaks, California PB - Sage Publications Inc. AB - The decision aid called ''Adjuvant Online'' (Adjuvant! for short) helps breast cancer patients make treatment decisions by providing numerical estimates of treatment efficacy (e.g., 10-y relapse or survival). Studies exploring how patients' numeracy interacts with the estimates provided by Adjuvant! are lacking. Pooling across 2 studies totaling 105 women with estrogen receptor-positive, early-stage breast cancer, the authors explored patients' treatment expectations, perceived benefit from treatments, and confidence of personal benefit from treatments. Patients who were more numerate were more likely to provide estimates of cancer-free survival that matched the estimates provided by Adjuvant! for each treatment option compared with patients with lower numeracy (odds ratios of 1.6 to 2.4). As estimates of treatment efficacy provided by Adjuvant! increased, so did patients' estimates of cancer-free survival (0.37 > r(s) > 0.48) and their perceptions of treatment benefit from hormonal therapy (r(s) = 0.28) and combined therapy (r(s) = 0.27). These relationships were significantly more pronounced for those with higher numeracy, especially for perceived benefit of combined therapy. Results suggest that numeracy influences a patient's ability to interpret numerical estimates of treatment efficacy from decision aids such as Adjuvant!. SN - 0272-989X AD - Duke University School of Nursing, Durham, NC, USA. isaac.lipkus@duke.edu U2 - PMID: 20160070. DO - 10.1177/0272989X09360371 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105065353&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104916026 T1 - Incorporating equity-efficiency interactions in cost-effectiveness analysis-three approaches applied to breast cancer control. AU - Baeten SA AU - Baltussen RM AU - Uyl-de Groot CA AU - Bridges J AU - Niessen LW Y1 - 2010/07//Jul/Aug2010 N1 - Accession Number: 104916026. Language: English. Entry Date: 20110107. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 100883818. KW - Breast Neoplasms -- Economics KW - Productivity KW - Health Status KW - Age Factors KW - Aged KW - Breast Neoplasms -- Drug Therapy KW - Breast Neoplasms -- Surgery KW - Cost Benefit Analysis -- Economics KW - Decision Support Techniques KW - Female KW - Health Services Accessibility -- Economics KW - Human KW - Probability KW - Models, Statistical KW - Neoplasm Staging -- Economics KW - Netherlands KW - Quality-Adjusted Life Years KW - World Health Organization SP - 573 EP - 579 JO - Value in Health JF - Value in Health JA - VALUE HEALTH VL - 13 IS - 5 CY - New York, New York PB - Elsevier B.V. SN - 1098-3015 AD - Institutes of Health Policy & Management and of Medical Technology Assessment, Erasmus Medical Centre, Rotterdam, The Netherlands; U2 - PMID: 20384980. DO - 10.1111/j.1524-4733.2010.00718.x UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104916026&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105030524 T1 - Patient decisions about breast cancer chemoprevention: a systematic review and meta-analysis. AU - Ropka ME AU - Keim J AU - Philbrick JT AU - Ropka, Mary E AU - Keim, Jess AU - Philbrick, John T Y1 - 2010/06/20/ N1 - Accession Number: 105030524. Language: English. Entry Date: 20100723. Revision Date: 20161116. Publication Type: journal article; meta analysis; research; systematic review. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Evidence-Based Practice; Oncologic Care. Grant Information: R21 NR009868/NR/NINR NIH HHS/United States. NLM UID: 8309333. KW - Antineoplastic Agents -- Therapeutic Use KW - Attitude to Health KW - Breast Neoplasms -- Prevention and Control KW - Decision Making KW - CINAHL Database KW - Female KW - Human KW - Medline KW - Meta Analysis KW - Psycinfo KW - Systematic Review SP - 3090 EP - 3095 JO - Journal of Clinical Oncology JF - Journal of Clinical Oncology JA - J CLIN ONCOL VL - 28 IS - 18 CY - Alexandria, Virginia PB - American Society of Clinical Oncology AB - Purpose: Women at high risk of breast cancer face the complex decision of whether to take tamoxifen or raloxifene for breast cancer chemoprevention. We investigated what is known about decisions of women regarding chemoprevention.Methods: Using MEDLINE, CINAHL, and PSYCINFO, plus reviewing reference lists of relevant articles, in December 2009 we identified 13 studies that addressed patient decisions about breast cancer chemoprevention, were published in 1995 or later, were peer-reviewed primary clinical studies, and reported rates at which participants showed interest in (hypothetical uptake) or accepted (real uptake) chemoprevention medications.Results: Nine studies provided information about hypothetical breast cancer chemoprevention decisions (mean uptake rate, 24.7%) and five provided information about real decisions (mean uptake rate, 14.8%). The range of rates was wide, and each of the hypothetical uptake studies assessed interest differently. A logistic regression model found significant correlation with uptake of decision type (hypothetical versus real, odds ratio [OR] = 1.65; 95% CI, 1.26 to 2.16), educational or decision support intervention (provided v not, OR = 0.21; 95% CI, 0.17 to 0.27), and cohort risk for breast cancer (high-risk v general population, OR = 0.65; 95% CI, 0.56 to 0.75). Perceived vulnerability to breast cancer was consistently correlated with increased uptake, and concern for adverse effects was correlated with reduced uptake. All studies used a correlational/descriptive design, and most studies used convenience sampling strategies.Conclusion: Breast cancer chemoprevention uptake rates are low and variation is wide. Hypothetical uptake rates are higher than real uptake, and interventions markedly reduce uptake. Research is needed that uses reproducible sampling methods and examines decision support strategies that lead to quality decisions. SN - 0732-183X AD - Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA 22908, USA AD - Department of Public Health Sciences, Box 800717, University of Virginia School of Medicine, Charlottesville, VA 22908; mer2e@virginia.edu. U2 - PMID: 20458026. DO - 10.1200/JCO.2009.27.8077 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105030524&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105024839 T1 - Improving Bayesian credibility intervals for classifier error rates using maximum entropy empirical priors. AU - Gustafsson MG AU - Wallman M AU - Wickenberg Bolin U AU - Göransson H AU - Fryknäs M AU - Andersson CR AU - Isaksson A Y1 - 2010/06// N1 - Accession Number: 105024839. Language: English. Entry Date: 20100917. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Blind Peer Reviewed; Computer/Information Science; Continental Europe; Europe; Expert Peer Reviewed; Peer Reviewed. Special Interest: Informatics. NLM UID: 8915031. KW - Artificial Intelligence KW - Probability KW - Data Mining KW - Databases KW - Decision Support Systems, Clinical KW - Models, Statistical KW - Algorithms KW - Breast Neoplasms -- Classification KW - Breast Neoplasms -- Diagnosis KW - Computer Simulation KW - Decision Trees KW - Empirical Research KW - Female KW - Proteins -- Classification KW - Proteins -- Physiology KW - Human KW - Linear Regression KW - Statistics KW - Predictive Value of Tests KW - Prognosis KW - Reproducibility of Results KW - Vocabulary, Controlled SP - 93 EP - 104 JO - Artificial Intelligence in Medicine JF - Artificial Intelligence in Medicine JA - ARTIF INTELL MED VL - 49 IS - 2 PB - Elsevier B.V. SN - 0933-3657 AD - Uppsala University, Department of Medical Sciences, Academic Hospital, 751 85 Uppsala, Sweden. Mats.Gustafsson@medsci.uu.se U2 - PMID: 20347582. DO - 10.1016/j.artmed.2010.02.004 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105024839&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105065910 T1 - Economic implications of 21-gene breast cancer risk assay from the perspective of an Israeli-managed health-care organization. AU - Klang SH AU - Hammerman A AU - Liebermann N AU - Efrat N AU - Doberne J AU - Hornberger J Y1 - 2010/06//Jun/Jul2010 N1 - Accession Number: 105065910. Language: English. Entry Date: 20101008. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 100883818. KW - Breast Neoplasms -- Pathology KW - Chemotherapy, Adjuvant -- Economics KW - Genetic Screening -- Economics KW - Genetic Techniques -- Economics KW - Health Care Costs KW - Adult KW - Aged KW - Aged, 80 and Over KW - Breast Neoplasms -- Drug Therapy KW - Cost Benefit Analysis KW - Decision Support Techniques KW - Female KW - Human KW - Israel KW - Middle Age KW - Quality-Adjusted Life Years KW - Recurrence KW - Reproducibility of Results KW - Risk Assessment KW - Survival Analysis SP - 381 EP - 387 JO - Value in Health JF - Value in Health JA - VALUE HEALTH VL - 13 IS - 4 CY - New York, New York PB - Elsevier B.V. SN - 1098-3015 AD - Clalit Health Services, Tel-Aviv, Israel; U2 - PMID: 20412544. DO - 10.1111/j.1524-4733.2010.00724.x UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105065910&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - ID - 105206539 T1 - Comparing breast cancer risk assessment models. AU - Gail MH AU - Mai PL AU - Gail, Mitchell H AU - Mai, Phuong L Y1 - 2010/05/19/ N1 - Accession Number: 105206539. Language: English. Entry Date: 20100618. Revision Date: 20170411. Publication Type: editorial; editorial. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Oncologic Care. NLM UID: 7503089. KW - Breast Neoplasms -- Epidemiology KW - Breast Neoplasms -- Etiology KW - Decision Support Techniques KW - Genetic Screening KW - Models, Statistical KW - Breast Neoplasms KW - Breast Neoplasms -- Prevention and Control KW - Female KW - Genes, BRCA KW - Disease Susceptibility KW - Mutation KW - Great Britain KW - Mammography KW - Health Screening KW - Population Surveillance KW - Predictive Value of Tests KW - Risk Assessment KW - Risk Factors KW - United States SP - 665 EP - 668 JO - JNCI: Journal of the National Cancer Institute JF - JNCI: Journal of the National Cancer Institute JA - J NATL CANCER INST VL - 102 IS - 10 PB - Oxford University Press / USA SN - 0027-8874 AD - Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Blvd, Rm 8032, Bethesda, MD 20892-7244. gailm@mail.nih.gov. U2 - PMID: 20427429. DO - 10.1093/jnci/djq141 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105206539&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105206540 T1 - Assessing women at high risk of breast cancer: a review of risk assessment models. AU - Amir E AU - Freedman OC AU - Seruga B AU - Evans DG AU - Amir, Eitan AU - Freedman, Orit C AU - Seruga, Bostjan AU - Evans, D Gareth Y1 - 2010/05/19/ N1 - Accession Number: 105206540. Language: English. Entry Date: 20100618. Revision Date: 20170411. Publication Type: journal article; research. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Oncologic Care. NLM UID: 7503089. KW - Breast Neoplasms -- Epidemiology KW - Breast Neoplasms -- Etiology KW - Mutation KW - Models, Statistical KW - Population Surveillance KW - Breast Diseases -- Pathology KW - Breast Diseases -- Radiography KW - Breast Neoplasms KW - Breast Neoplasms -- Prevention and Control KW - Confounding Variable KW - Decision Support Techniques KW - Female KW - Genes, BRCA KW - Disease Susceptibility KW - Genetic Screening KW - Human KW - Mammography KW - Health Screening -- Methods KW - Predictive Value of Tests KW - Reproduction KW - Risk Assessment KW - Risk Factors KW - Time Factors SP - 680 EP - 691 JO - JNCI: Journal of the National Cancer Institute JF - JNCI: Journal of the National Cancer Institute JA - J NATL CANCER INST VL - 102 IS - 10 PB - Oxford University Press / USA AB - Women who are at high risk of breast cancer can be offered more intensive surveillance or prophylactic measures, such as surgery or chemoprevention. Central to decisions regarding the level of prevention is accurate and individualized risk assessment. This review aims to distill the diverse literature and provide practicing clinicians with an overview of the available risk assessment methods. Risk assessments fall into two groups: the risk of carrying a mutation in a high-risk gene such as BRCA1 or BRCA2 and the risk of developing breast cancer with or without such a mutation. Knowledge of breast cancer risks, taken together with the risks and benefits of the intervention, is needed to choose an appropriate disease management strategy. A number of models have been developed for assessing these risks, but independent validation of such models has produced variable results. Some models are able to predict both mutation carriage risks and breast cancer risk; however, to date, all are limited by only moderate discriminatory accuracy. Further improvements in the knowledge of how to best integrate both new risk factors and newly discovered genetic variants into these models will allow clinicians to more accurately determine which women are most likely to develop breast cancer. These steady and incremental improvements in models will need to undergo revalidation. SN - 0027-8874 AD - Division of Medical Oncology and Hematology, Princess Margaret Hospital, 610 University Ave, Toronto, ON M5G2M9, Canada AD - MB ChB, Division of Medical Oncology and Hematology, Princess Margaret Hospital, 610 University Ave, Toronto, ON, Canada M5G 2M9. eitan.amir@uhn.on.ca. U2 - PMID: 20427433. DO - 10.1093/jnci/djq088 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105206540&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105194223 T1 - Effect of changing breast cancer incidence rates on the calibration of the Gail model. AU - Schonfeld SJ AU - Pee D AU - Greenlee RT AU - Hartge P AU - Lacey JV Jr AU - Park Y AU - Schatzkin A AU - Visvanathan K AU - Pfeiffer RM AU - Schonfeld, Sara J AU - Pee, David AU - Greenlee, Robert T AU - Hartge, Patricia AU - Lacey, James V Jr AU - Park, Yikyung AU - Schatzkin, Arthur AU - Visvanathan, Kala AU - Pfeiffer, Ruth M Y1 - 2010/05/10/ N1 - Accession Number: 105194223. Language: English. Entry Date: 20100604. Revision Date: 20161116. Publication Type: journal article; research. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Oncologic Care. Instrumentation: Clinical Decision Making in Nursing Scale (CDMNS) (Jenkins). Grant Information: //Intramural NIH HHS/United States. NLM UID: 8309333. KW - Breast Neoplasms -- Epidemiology KW - Decision Support Techniques KW - Models, Statistical KW - Demography KW - Age Factors KW - Breast Neoplasms -- Mortality KW - Breast Neoplasms -- Pathology KW - Breast Neoplasms -- Therapy KW - Calibration KW - Female KW - Human KW - Incidence KW - Middle Age KW - Neoplasm Invasiveness KW - Patient Selection KW - Cox Proportional Hazards Model KW - Reproducibility of Results KW - Risk Assessment KW - Risk Factors KW - Registries, Disease KW - Time Factors KW - United States KW - Scales SP - 2411 EP - 2417 JO - Journal of Clinical Oncology JF - Journal of Clinical Oncology JA - J CLIN ONCOL VL - 28 IS - 14 CY - Alexandria, Virginia PB - American Society of Clinical Oncology AB - Purpose: The Gail model combines relative risks (RRs) for five breast cancer risk factors with age-specific breast cancer incidence rates and competing mortality rates from the Surveillance, Epidemiology, and End Results (SEER) program from 1983 to 1987 to predict risk of invasive breast cancer over a given time period. Motivated by changes in breast cancer incidence during the 1990s, we evaluated the model's calibration in two recent cohorts.Methods: We included white, postmenopausal women from the National Institutes of Health (NIH) -AARP Diet and Health Study (NIH-AARP, 1995 to 2003), and the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO, 1993 to 2006). Calibration was assessed by comparing the number of breast cancers expected from the Gail model with that observed. We then evaluated calibration by using an updated model that combined Gail model RRs with 1995 to 2003 SEER invasive breast cancer incidence rates.Results: Overall, the Gail model significantly underpredicted the number of invasive breast cancers in NIH-AARP, with an expected-to-observed ratio of 0.87 (95% CI, 0.85 to 0.89), and in PLCO, with an expected-to-observed ratio of 0.86 (95% CI, 0.82 to 0.90). The updated model was well-calibrated overall, with an expected-to-observed ratio of 1.03 (95% CI, 1.00 to 1.05) in NIH-AARP and an expected-to-observed ratio of 1.01 (95% CI: 0.97 to 1.06) in PLCO. Of women age 50 to 55 years at baseline, 13% to 14% had a projected Gail model 5-year risk lower than the recommended threshold of 1.66% for use of tamoxifen or raloxifene but >or= 1.66% when using the updated model. The Gail model was well calibrated in PLCO when the prediction period was restricted to 2003 to 2006.Conclusion: This study highlights that model calibration is important to ensure the usefulness of risk prediction models for clinical decision making. SN - 0732-183X AD - Biostatistics Branch, Division of Cancer Epidemiology and Genetics, 6120 Executive Blvd, Bethesda, MD 20892, USA AD - Biostatistics Branch, Division of Cancer Epidemiology and Genetics, 6120 Executive Blvd, Bethesda, MD 20892, USA. pfeiffer@mail.nih.gov U2 - PMID: 20368565. DO - 10.1200/JCO.2009.25.2767 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105194223&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105021215 T1 - Review of the clinical studies using the 21-gene assay. AU - Kelly CM AU - Warner E AU - Tsoi DT AU - Verma S AU - Pritchard KI Y1 - 2010/05// N1 - Accession Number: 105021215. Language: English. Entry Date: 20100723. Revision Date: 20150711. Publication Type: Journal Article; review; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Oncologic Care. NLM UID: 9607837. KW - Breast Neoplasms -- Familial and Genetic KW - Chemotherapy, Adjuvant KW - Decision Making, Clinical KW - Genetic Techniques -- Evaluation KW - Risk Assessment -- Methods KW - Female KW - Neoplasm Recurrence, Local KW - Patient Selection KW - Prognosis KW - Receptors, Cell Surface KW - Reverse Transcriptase Polymerase Chain Reaction SP - 447 EP - 456 JO - Oncologist JF - Oncologist JA - ONCOLOGIST VL - 15 IS - 5 CY - Durham, North Carolina PB - AlphaMed Company, Inc., dba AlphaMed Press AB - PURPOSE: A major challenge in treating early-stage hormone receptor (HR)(+) breast cancer is selecting women who, after initial surgery, do not require chemotherapy. Better prognostic and predictive tests are needed. The 21-gene assay is the only widely commercially available gene signature that can be performed on formalin-fixed paraffin-embedded tissue. METHODS: We conducted a review of the literature supporting the prognostic and predictive ability of the 21-gene assay in HR(+) node-negative and node-positive breast cancer patients in chemotherapy-/endocrine-treated and untreated populations. We considered: (a) How accurate is the recurrence score (RS) as a prognostic factor for distant recurrence? (b) How accurate is the RS as a predictive factor for benefit from systemic therapy? (c) How does the RS compare with other prognostic/predictive factors such as tumor size, tumor grade, patient age, and integrated decision aids such as Adjuvant! Online? (d) How do patients and physicians view the 21-gene assay? (e) What are the cost implications of the 21-gene assay? RESULTS: The 21-gene assay: (a) provided accurate risk information; (b) predicted response to cyclophosphamide, methotrexate, and 5-fluorouracil and to cyclophosphamide, doxorubicin, and 5-fluorouracil chemotherapy; (c) added additional information to traditional biomarkers; (d) was viewed positively by both physicians and patients; and (e) fell within the cost-effectiveness values in North America. CONCLUSION: This assay may be offered to patients with node-negative HR(+) breast cancer to assist in adjuvant treatment decisions. Data are accumulating to support the use of the 21-gene assay in HR(+) node-positive patients. SN - 1083-7159 AD - Division of Medical Oncology, Sunnybrook Odette Cancer Centre, The University of Toronto, Toronto, Ontario, Canada, M4N 3M5. U2 - PMID: 20421266. DO - 10.1634/theoncologist.2009-0277 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105021215&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105021213 T1 - Cost-effectiveness analysis of recurrence score-guided treatment using a 21-gene assay in early breast cancer. AU - Tsoi DT AU - Inoue M AU - Kelly CM AU - Verma S AU - Pritchard KI Y1 - 2010/05// N1 - Accession Number: 105021213. Language: English. Entry Date: 20100723. Revision Date: 20150711. Publication Type: Journal Article; algorithm; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Oncologic Care. NLM UID: 9607837. KW - Breast Neoplasms -- Economics KW - Breast Neoplasms -- Familial and Genetic KW - Decision Making, Clinical KW - Genetic Techniques KW - Risk Assessment -- Methods KW - Canada KW - Chemotherapy, Adjuvant KW - Comparative Studies KW - Cost Benefit Analysis KW - Female KW - Human KW - Neoplasm Recurrence, Local KW - Neoplasm Staging KW - Probability KW - Quality-Adjusted Life Years KW - Receptors, Cell Surface SP - 457 EP - 465 JO - Oncologist JF - Oncologist JA - ONCOLOGIST VL - 15 IS - 5 CY - Durham, North Carolina PB - AlphaMed Company, Inc., dba AlphaMed Press AB - PURPOSE: Most guidelines for hormone receptor (HR)-positive early breast cancer recommend addition of adjuvant chemotherapy for most women, leading to overtreatment, which causes considerable morbidity and cost. There has been recent incorporation of gene expression analysis in aiding decision making. We evaluated the cost-effectiveness of recurrence score (RS)-guided treatment using 21-gene assay as compared with treatment guided by the Adjuvant! Online program (AOL). PATIENTS AND METHODS: A Markov model was developed to compare the cost-effectiveness of treatment guided either by 21-gene assay or by AOL in a 50-year-old woman with lymph node-negative HR-positive breast cancer over a lifetime horizon. We assumed that women classified to be at high risk all received chemotherapy followed by tamoxifen and those classified to be at low risk received tamoxifen only. The model took a health care payer's perspective with results reported in 2008 Canadian dollars ($). Event rates, costs, and utilities were derived from the literature. Both costs and benefits were discounted at 5%. Outcome measures were life years gained, quality-adjusted life years (QALYs), lifetime costs, and incremental cost-effectiveness ratios (ICERs). RESULTS: For a 50-year-old woman, RS-guided treatment was associated with an incremental lifetime cost of $4,102 and a gain in 0.065 QALY, with an ICER of $63,064 per QALY compared with AOL-guided treatment. ICER increased with increasing cost of 21-gene assay and increasing age of patients. Results were most sensitive to probabilities relating to risk categorization and recurrence rate. CONCLUSIONS: The 21-gene assay appears cost-effective from a Canadian health care perspective. SN - 1083-7159 AD - Division of Medical Oncology, Sunnybrook Odette Cancer Centre, The University of Toronto, Toronto, Ontario M4N 3M5, Canada. U2 - PMID: 20421264. DO - 10.1634/theoncologist.2009-0275 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105021213&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104947087 T1 - Can biomarkers improve ability of NPI in risk prediction? A decision tree model analysis. AU - Baneshi, MR AU - Warner, P AU - Anderson, N AU - Tovey, S AU - Edwards, J AU - Bartlett, JMS Y1 - 2010///2010 Spring N1 - Accession Number: 104947087. Language: English. Entry Date: 20110128. Revision Date: 20171010. Publication Type: Journal Article; equations & formulas; research; tables/charts. Journal Subset: Biomedical; Middle East; Peer Reviewed. Special Interest: Oncologic Care. Instrumentation: Nottingham Prognostic Index (NPI). Grant Information: Ministry of Health and Medical Education of Iran and Kerman Medical University. NLM UID: 101500574. KW - Biological Markers KW - Breast Neoplasms -- Diagnosis KW - Models, Biological KW - Cancer Patients -- Evaluation KW - Data Analysis -- Methods KW - Female KW - Funding Source KW - Health Screening -- Methods KW - Human KW - Kaplan-Meier Estimator KW - Neoplasm Staging -- Methods KW - Neoplasms -- Prevention and Control KW - Outcomes (Health Care) KW - Scales KW - Sentinel Lymph Node Biopsy -- Methods KW - Survival Analysis SP - 62 EP - 74 JO - Iranian Journal of Cancer Prevention JF - Iranian Journal of Cancer Prevention JA - IRANIAN J CANCER PREV VL - 3 IS - 2 PB - Medical Journals Commission of the Ministry of Health & Medical Education SN - 2008-2398 AD - Health School, Kerman Medical University, Department of Biostatistics and Epidemiology, Kerman, Iran; rbaneshi@yahoo.com AD - Centre for Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh, UK AD - Section of Surgical and Translational Sciences, Division of Cancer Sciences and Molecular Pathology, Glasgow Royal Infirmary, Glasgow, UK AD - Endocrine Cancer Group, University of Edinburgh, Edinburgh; Cancer Research Centre, Western General Hospital, Crewer Road South, Edinburgh, UK UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104947087&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105135296 T1 - Attitudes of Canadian radiation oncologists towards post-lumpectomy radiotherapy for elderly women with stage I hormone-responsive breast cancer. AU - Warner E AU - Chow E AU - Fairchild A AU - Franssen E AU - Paszat L AU - Szumacher E Y1 - 2010/03// N1 - Accession Number: 105135296. Language: English. Entry Date: 20100423. Revision Date: 20150711. Publication Type: Journal Article; questionnaire/scale; research; tables/charts. Journal Subset: Biomedical; Double Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. Special Interest: Evidence-Based Practice; Oncologic Care. Grant Information: Astra Zeneca Educational Fund. NLM UID: 9002902. KW - Breast Neoplasms KW - Lumpectomy KW - Physician Attitudes KW - Radiologists KW - Radiotherapy KW - Case Studies KW - Data Analysis Software KW - Demography KW - Descriptive Statistics KW - Funding Source KW - Human KW - Oncology KW - Ontario KW - Questionnaires SP - 97 EP - 106 JO - Clinical Oncology JF - Clinical Oncology JA - CLIN ONCOL VL - 22 IS - 2 CY - Philadelphia, Pennsylvania PB - W B Saunders AB - AIMS: Post-lumpectomy breast radiation is the standard of care for all patient subgroups. However, elderly women with stage I breast cancer on adjuvant tamoxifen therapy have a 4% risk of local recurrence after lumpectomy without adjuvant breast radiation. The purpose of this study was to explore the attitudes of Canadian radiation oncologists who treat breast cancer with respect to their use of adjuvant post-lumpectomy radiotherapy, and their willingness to implement a decision aid for this patient population. MATERIALS AND METHODS: The questionnaire was mailed to 141 Canadian radiation oncologists who treat breast cancer. The respondents were asked to complete an online survey consisting of four parts: (1) demographic information; (2) factors determining post-lumpectomy radiation treatment decisions; (3) hypothetical case scenarios; (4) interest in using a decision aid in their practice. RESULTS: Among the 61 (43%) physicians who completed the survey, there was substantial response variation. After contraindications to radiotherapy, patient overall health and patient preference had the greatest influence on their decision to offer radiotherapy to this patient subgroup. Margin status and use of hormonal therapy were given less importance. For each of the case scenarios, 60-83% of physicians (depending on the case scenario) would offer the patient a choice; far fewer (12-57%) would be comfortable not irradiating. Sixty-four per cent of respondents welcomed the concept of a decision aid for this population. CONCLUSIONS: Although there is significant variation in practice patterns and attitudes among radiation oncologists regarding post-lumpectomy radiotherapy for elderly, low-risk breast cancer patients, the vast majority value patient choice and would be willing to use a decision aid designed for this population in their practice. SN - 0936-6555 AD - Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada. U2 - PMID: 19883996. DO - 10.1016/j.clon.2009.10.001 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105135296&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105161998 T1 - First-line treatment of metastatic breast cancer: current strategies and emerging systemic therapies. AU - Brufsky A Y1 - 2010/03//2010 Mar N1 - Accession Number: 105161998. Language: English. Entry Date: 20100514. Revision Date: 20150711. Publication Type: Journal Article; review; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Oncologic Care; Women's Health. NLM UID: 101223547. KW - Breast Neoplasms -- Drug Therapy KW - Breast Neoplasms -- Therapy KW - Neoplasm Metastasis -- Drug Therapy KW - Neoplasm Metastasis -- Therapy KW - Drug Resistance, Neoplasm KW - Drug Therapy, Combination KW - Endocrine System KW - Female KW - Gemcitabine -- Therapeutic Use KW - Paclitaxel -- Analogs and Derivatives KW - Paclitaxel -- Therapeutic Use SP - 115 EP - 123 JO - Community Oncology JF - Community Oncology JA - COMMUNITY ONCOL VL - 7 IS - 3 PB - Elsevier B.V. AB - Prognosis is poor after a diagnosis of metastatic breast cancer (MBC), with a median survival of 2-4 years. Individualized treatment is aimed at stabilizing disease without decreasing quality of life. To aid oncologists in decision-making, this review discusses current systemic strategies for first-line treatment of MBC, with a particular focus on the possible role of emerging therapies. It is intended to be an overview that places new findings in the context of existing first-line options for MBC. Evidence suggests that although anthracyclines and taxanes are considered to be the most active agents in MBC, their increased use in the neoadjuvant and adjuvant settings has made resistance to these agents more common. Given this issue and others, alternative agents are increasingly used for first-line treatment of MBC. Gemcitabine and bevacizumab are indicated in this setting in combination with paclitaxel. Emerging agents include nanoparticle albumin-bound (nab)-paclitaxel and ixabepilone. nab-Paclitaxel is active in patients previously treated with taxanes, or both in the neoadjuvant or adjuvant setting, a possible indication of resistance to these agents. Efficacy in patients with disease resistant to anthracyclines, taxanes, or both is of particular importance, because this population has few effective treatment options. SN - 1548-5315 AD - Women's Cancer Center, Magee-Womens Hospital, Pittsburgh, PA; brufskyam@upmc.edu UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105161998&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105310712 T1 - Diagnostic performance of breast technologists in reading mammograms in a clinical patient population. AU - van den Biggelaar FJH AU - Kessels AGH AU - van Engelshoven JMA AU - Flobbe K AU - van den Biggelaar, F J H M AU - Kessels, A G H AU - van Engelshoven, J M A AU - Flobbe, K Y1 - 2010/03// N1 - Accession Number: 105310712. Language: English. Entry Date: 20100326. Revision Date: 20170411. Publication Type: journal article; research; tables/charts. Commentary: Fentiman IS. Who finds breast lumps? (INT J CLIN PRACT) Mar2010; 64 (4): 416-418. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care; Women's Health. Grant Information: The Netherlands Organisation for Health Research and Development (ZonMW). NLM UID: 9712381. KW - Breast Neoplasms -- Radiography KW - Diagnostic Errors KW - Mammography KW - Radiologists KW - Academic Medical Centers KW - Adult KW - Aged KW - Aged, 80 and Over KW - Breast Neoplasms -- Epidemiology KW - Clinical Competence KW - Confidence Intervals KW - Data Analysis Software KW - Descriptive Statistics KW - False Negative Results KW - False Positive Results KW - Female KW - Funding Source KW - Hospital Units KW - Human KW - Kappa Statistic KW - Middle Age KW - Netherlands KW - Odds Ratio KW - Prevalence KW - Radiologists -- Manpower KW - Sensitivity and Specificity KW - Workload SP - 442 EP - 450 JO - International Journal of Clinical Practice JF - International Journal of Clinical Practice JA - INT J CLIN PRACT VL - 64 IS - 4 CY - Malden, Massachusetts PB - Wiley-Blackwell AB - Purpose: In the setting of an increasing workload for radiologists, this study focuses on the feasibility of skill mixing in breast imaging in a hospital radiology department. Methods: Two radiological technologists with more than 10 years of experience in performing mammograms were trained in prereading mammograms to select the cases that require further evaluation by a radiologist. Mammograms of consecutive patients were independently evaluated by the technologists, next to the standard clinical interpretation by the radiologist on duty. Mammographic findings were recorded and a BI-RADS classification was assigned for each breast. Different prereading scenarios were analysed using clinical decision rules. Two different cut-off points of BI-RADS classifications were applied to the data. Analysis was performed for the overall clinical patient population as well as for a subgroup of patients with no immediate indication for further work-up. Results: Mammograms of 1994 patients were evaluated. In total, 93 breast cancers were found in 91 patients (prevalence 4.6%). Sensitivity and specificity in selecting mammographic findings (cut-off point between BI-RADS 1 and BI-RADS 0, 2-5 and the radiologist's diagnosis as reference standard) was 98% and 74% for technologist 1 and 98% and 78% for technologist 2. In distinguishing normal and benign mammograms from those with abnormalities that are probably benign, suspicious or highly suggestive for malignancy (cut-off point BI-RADS 1-2 and BI-RADS 0, 3-5 and pathology results as reference standard), sensitivity decreased to 89% and 91% respectively. Specificity increased to 82% for both technologists. In a subgroup of 1389 patients with no immediate indication for additional imaging with the involvement of a radiologist, technologists obtained a mean sensitivity and specificity of 98% and 77% in detecting mammographic findings, and a mean sensitivity and specificity of 78% and 88% in detecting suspicious abnormalities. Conclusions: The employment of technologists in prereading mammograms seems to be an effective working strategy in daily clinical practice. However, its position in clinical practice remains indistinct as a continuous availability of radiologists still needs to be guaranteed. Nevertheless, as a substantial proportion of mammograms could be evaluated without the attention of a radiologist, the employment of technologists in prereading mammograms seems a promising new working strategy. SN - 1368-5031 AD - Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands U2 - PMID: 20456190. DO - 10.1111/j.1742-1241.2009.02310.x UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105310712&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105156714 T1 - Frozen hope: fertility preservation for women with cancer. AU - Quinn GP AU - Vadaparampil ST AU - Jacobsen PB AU - Knapp C AU - Keefe DL AU - Bell GE Y1 - 2010/03//Mar/Apr2010 N1 - Accession Number: 105156714. Corporate Author: Moffitt Fertility Preservation Group. Language: English. Entry Date: 20100521. Revision Date: 20170802. Publication Type: Journal Article; case study; tables/charts. Journal Subset: Core Nursing; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Nursing; Peer Reviewed; USA. Special Interest: Advanced Nursing Practice; Obstetric Care; Women's Health. NLM UID: 100909407. KW - Breast Neoplasms -- Familial and Genetic KW - Cancer Survivors KW - Heterozygote KW - Fertility KW - Reproduction Techniques KW - Adult KW - Communication KW - Counseling KW - Cryopreservation KW - Decision Making, Patient -- Ethical Issues KW - Female KW - Information Resources KW - Patient Education KW - Physician-Patient Relations KW - Preimplantation Diagnosis KW - Reproduction Techniques -- Ethical Issues KW - World Wide Web SP - 175 EP - 180 JO - Journal of Midwifery & Women's Health JF - Journal of Midwifery & Women's Health JA - J MIDWIFERY WOMENS HEALTH VL - 55 IS - 2 CY - Malden, Massachusetts PB - Wiley-Blackwell AB - Young women diagnosed with cancer have the option of preserving their fertility by using assisted reproductive technology (ART) techniques prior to undergoing cancer treatment. This article presents a composite case of a young woman with cancer who had many unanswered emotional and ethical questions about her future as a parent. Fertility preservation techniques, including preimplantation genetic diagnosis (PGD), and related patient education are described. Current literature regarding reproductive counseling for cancer survivors is reviewed. Resources for providing psychosocial support for decisions about fertility preservation are lagging behind the rapid pace of scientific advancements in cancer treatment and ART. As more young women are surviving cancer and taking steps to preserve fertility, there is great need for the provision of psychologic support services and the establishment of ethical guidelines to aid them on this path. Women's health care providers can provide support to cancer survivors facing fertility and parenting issues by becoming knowledgeable about the long-term aspects of decision making and developing educational materials and guidelines for these patients. SN - 1526-9523 AD - Moffitt Cancer Center - USF Health Outcomes, 12902 Magnolia Drive, MRC CANCONT, Tampa, FL 33612, USA. gwen.quinn@moffitt.org U2 - PMID: 20189137. DO - 10.1016/j.jmwh.2009.07.009 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105156714&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105316834 T1 - Breast conservation treatment with radiation: an ongoing success story. AU - Solin LJ Y1 - 2010/02/10/ N1 - Accession Number: 105316834. Language: English. Entry Date: 20100326. Revision Date: 20150711. Publication Type: Journal Article; editorial. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Oncologic Care. NLM UID: 8309333. KW - Breast Neoplasms -- Radiotherapy KW - Breast Neoplasms -- Surgery KW - Lumpectomy KW - Neoplasm Recurrence, Local KW - Breast Neoplasms -- Pathology KW - Decision Support Techniques KW - Female KW - Internet KW - Models, Biological KW - Models, Statistical KW - Radiotherapy, Adjuvant KW - Risk Assessment KW - Risk Factors KW - Time Factors KW - Treatment Outcomes SP - 709 EP - 711 JO - Journal of Clinical Oncology JF - Journal of Clinical Oncology JA - J CLIN ONCOL VL - 28 IS - 5 CY - Alexandria, Virginia PB - American Society of Clinical Oncology SN - 0732-183X U2 - PMID: 20048173. DO - 10.1200/JCO.2009.26.1164 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105316834&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105316844 T1 - Validation of a web-based predictive nomogram for ipsilateral breast tumor recurrence after breast conserving therapy. AU - Sanghani M AU - Truong PT AU - Raad RA AU - Niemierko A AU - Lesperance M AU - Olivotto IA AU - Wazer DE AU - Taghian AG AU - Sanghani, Mona AU - Truong, Pauline T AU - Raad, Rita Abi AU - Niemierko, Andrzej AU - Lesperance, Mary AU - Olivotto, Ivo A AU - Wazer, David E AU - Taghian, Alphonse G Y1 - 2010/02/10/ N1 - Accession Number: 105316844. Language: English. Entry Date: 20100326. Revision Date: 20161116. Publication Type: journal article; research. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Oncologic Care. Grant Information: R01 CA050628/CA/NCI NIH HHS/United States. NLM UID: 8309333. KW - Breast Neoplasms -- Surgery KW - Decision Support Techniques KW - Internet KW - Lumpectomy KW - Models, Biological KW - Neoplasm Recurrence, Local KW - Models, Statistical KW - Adult KW - Aged KW - Breast Neoplasms -- Pathology KW - Breast Neoplasms -- Radiotherapy KW - British Columbia KW - Databases KW - Female KW - Human KW - Kaplan-Meier Estimator KW - Middle Age KW - Predictive Value of Tests KW - Cox Proportional Hazards Model KW - Radiotherapy, Adjuvant KW - Reproducibility of Results KW - Risk Assessment KW - Risk Factors KW - Time Factors KW - Treatment Outcomes KW - United States SP - 718 EP - 722 JO - Journal of Clinical Oncology JF - Journal of Clinical Oncology JA - J CLIN ONCOL VL - 28 IS - 5 CY - Alexandria, Virginia PB - American Society of Clinical Oncology AB - PURPOSE IBTR! version 1.0 is a web-based tool that uses literature-derived relative risk ratios for seven clinicopathologic variables to predict ipsilateral breast tumor recurrence (IBTR) after breast-conserving therapy (BCT). Preliminary testing demonstrated over-estimation in high-risk subgroups. This study uses two independent population-based datasets to create and validate a modified nomogram, IBTR! version 2.0. METHODS Cox regression modeling was performed on 7,811 patients treated with BCT at the British Columbia Cancer Agency (median follow-up, 9.4 years). Population-based hazard ratios were generated for the seven variables in the original nomogram. A modified nomogram was then tested against 664 patients from Massachusetts General Hospital (median follow-up, 9.3 years). The mean predicted and observed 10-year estimates were compared for the entire cohort and for four groups predefined by nomogram-predicted risks: group 1: less than 3%; group 2: 3% to 5%; group 3: 5% to 10%; and group 4: more than 10%. Results IBTR! version 2.0 predicted an overall 10-year IBTR estimate of 4.0% (95% CI, 3.8 to 4.2), while the observed estimate was 2.8% (95% CI, 1.6 to 4.7; P = .10). The predicted and observed IBTR estimates were: group 1 (n = 283): 2.2% versus 1.3%, P = .40; group 2 (n = 237): 3.8% versus 3.5%, P = .80; group 3 (n = 111): 6.7% versus 3.2%, P = .05; and group 4 (n = 33): 12.5% versus 8.7%, P = .50. CONCLUSION IBTR! version 2.0 is accurate in the majority of patients with a low to moderate risk of in-breast recurrence. The nomogram still overestimates risk in a minority of patients with higher risk features. Validation in a larger prospective data set is warranted. SN - 0732-183X AD - Department of Radiation Oncology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA AD - Department of Radiation Oncology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114; ataghian@partners.org. U2 - PMID: 20048188. DO - 10.1200/JCO.2009.22.6662 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105316844&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105125587 T1 - Perceptions of high-risk care and barriers to care among women at risk for hereditary breast and ovarian cancer following genetic counseling in the community setting. AU - Morgan D AU - Sylvester H AU - Lucas FL AU - Miesfeldt S Y1 - 2010/02// N1 - Accession Number: 105125587. Language: English. Entry Date: 20100409. Revision Date: 20150711. Publication Type: Journal Article. Journal Subset: Biomedical; Continental Europe; Europe; Peer Reviewed. Special Interest: Oncologic Care; Women's Health. NLM UID: 9206865. KW - Breast Neoplasms -- Familial and Genetic KW - Cancer Screening -- Psychosocial Factors KW - Genetic Counseling KW - Health Services Accessibility KW - Ovarian Neoplasms -- Familial and Genetic KW - Patients -- Psychosocial Factors KW - Adult KW - Aged KW - Descriptive Statistics KW - Female KW - Genetic Counseling -- Psychosocial Factors KW - Health Beliefs KW - Maine KW - Middle Age KW - Questionnaires KW - Surveys SP - 44 EP - 54 JO - Journal of Genetic Counseling JF - Journal of Genetic Counseling JA - J GENETIC COUNS VL - 19 IS - 1 CY - , PB - Springer Science & Business Media B.V. AB - Data are limited regarding barriers to care among women, with or at risk for hereditary breast and ovarian cancer (HBOC), following genetic counseling in the community setting. Using a telephone survey, we retrospectively addressed perceptions of post-genetic counseling medical care and barriers to care among 69 at-risk women from the non-academic setting. Of these, all agreed that following cancer screening recommendations was better than not following them; none felt recommendations were too difficult to follow; all believed screening would help keep them healthy; 57% believed screening would prevent cancer. Twenty-five percent noted discomfort with breast imaging; 29% found ovarian cancer screening uncomfortable. Close to a quarter of participants reported difficulty deciding whether or not to undergo risk-reducing mastectomy while 10% noted difficulty deciding for or against bilateral salpingo-oophorectomy. There were no perceived major barriers to care, although 38% felt that screening reminders would be helpful, and 10% needed more help in following through with care. Overall, participants believed that they were benefiting from their post-genetic counseling medical care. This work identified HBOC-related support needs to include: informational resources that promote improved understanding of cancer risk and high-risk management; screening reminder systems; and decision support tools. SN - 1059-7700 AD - Maine Medical Center Research Institute, Scarborough USA U2 - PMID: 19809867. DO - 10.1007/s10897-009-9261-9 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105125587&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105285558 T1 - Weighing options for cancer risk reduction in carriers of BRCA1 and BRCA2 mutations. AU - Stadler ZK AU - Kauff ND Y1 - 2010/01/10/ N1 - Accession Number: 105285558. Language: English. Entry Date: 20100205. Revision Date: 20150711. Publication Type: Journal Article; editorial. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Oncologic Care. NLM UID: 8309333. KW - Decision Support Techniques KW - Genes, BRCA KW - Neoplasms -- Mortality KW - Behavior KW - Adult KW - Aged KW - Fallopian Tubes KW - Female KW - Genital Neoplasms, Female -- Prevention and Control KW - Heterozygote KW - Mastectomy KW - Middle Age KW - Mutation KW - Neoplasms KW - Oophorectomy SP - 189 EP - 191 JO - Journal of Clinical Oncology JF - Journal of Clinical Oncology JA - J CLIN ONCOL VL - 28 IS - 2 CY - Alexandria, Virginia PB - American Society of Clinical Oncology SN - 0732-183X U2 - PMID: 19996025. DO - 10.1200/JCO.2009.25.6875 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105285558&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105285564 T1 - Survival analysis of cancer risk reduction strategies for BRCA1/2 mutation carriers. AU - Kurian AW AU - Sigal BM AU - Plevritis SK AU - Kurian, Allison W AU - Sigal, Bronislava M AU - Plevritis, Sylvia K Y1 - 2010/01/10/ N1 - Accession Number: 105285564. Language: English. Entry Date: 20100205. Revision Date: 20161116. Publication Type: journal article; research. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Oncologic Care. Grant Information: R01 CA66785/CA/NCI NIH HHS/United States. NLM UID: 8309333. KW - Breast Neoplasms -- Mortality KW - Genes, BRCA KW - Ovarian Neoplasms -- Mortality KW - Behavior KW - Adult KW - Aged KW - Breast Neoplasms KW - Cause of Death KW - Decision Support Techniques KW - Female KW - Heterozygote KW - Magnetic Resonance Imaging KW - Mammography KW - Mastectomy KW - Middle Age KW - Systems Analysis KW - Mutation KW - Ovarian Neoplasms KW - Oophorectomy SP - 222 EP - 231 JO - Journal of Clinical Oncology JF - Journal of Clinical Oncology JA - J CLIN ONCOL VL - 28 IS - 2 CY - Alexandria, Virginia PB - American Society of Clinical Oncology AB - Purpose: Women with BRCA1/2 mutations inherit high risks of breast and ovarian cancer; options to reduce cancer mortality include prophylactic surgery or breast screening, but their efficacy has never been empirically compared. We used decision analysis to simulate risk-reducing strategies in BRCA1/2 mutation carriers and to compare resulting survival probability and causes of death.Methods: We developed a Monte Carlo model of breast screening with annual mammography plus magnetic resonance imaging (MRI) from ages 25 to 69 years, prophylactic mastectomy (PM) at various ages, and/or prophylactic oophorectomy (PO) at ages 40 or 50 years in 25-year-old BRCA1/2 mutation carriers.Results: With no intervention, survival probability by age 70 is 53% for BRCA1 and 71% for BRCA2 mutation carriers. The most effective single intervention for BRCA1 mutation carriers is PO at age 40, yielding a 15% absolute survival gain; for BRCA2 mutation carriers, the most effective single intervention is PM, yielding a 7% survival gain if performed at age 40 years. The combination of PM and PO at age 40 improves survival more than any single intervention, yielding 24% survival gain for BRCA1 and 11% for BRCA2 mutation carriers. PM at age 25 instead of age 40 offers minimal incremental benefit (1% to 2%); substituting screening for PM yields a similarly minimal decrement in survival (2% to 3%).Conclusion: Although PM at age 25 plus PO at age 40 years maximizes survival probability, substituting mammography plus MRI screening for PM seems to offer comparable survival. These results may guide women with BRCA1/2 mutations in their choices between prophylactic surgery and breast screening. SN - 0732-183X AD - Departments of Medicine, Health Research and Policy, and Radiology, Stanford University School of Medicine, Stanford, CA, USA AD - Departments of Medicine, Health Research and Policy, and Radiology, Stanford University School of Medicine, Stanford, CA, USA. U2 - PMID: 19996031. DO - 10.1200/JCO.2009.22.7991 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105285564&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105291793 T1 - Ashley revisited: a response to the critics. AU - Diekema DS AU - Fost N Y1 - 2010/01// N1 - Accession Number: 105291793. Language: English. Entry Date: 20100319. Revision Date: 20150711. Publication Type: Journal Article; review; tables/charts. Commentary: Asch A, Stubblefield A. Growth attenuation: good intentions, bad decision. (AM J BIOETHICS) Jan2010; 10 (1): 46-48; Hester DM. What role should moral intuitions play when dealing with children? (AM J BIOETHICS) Jan2010; 10 (1): 56-56; Ouellette A. Putting law in the room. (AM J BIOETHICS) Jan2010; 10 (1): 48-50; Sobsey D. Ethics or advocacy? (AM J BIOETHICS) Jan2010; 10 (1): 59-60; Goering S. Revisiting the relevance of the social model of disability. (AM J BIOETHICS) Jan2010; 10 (1): 54-55; Lantos J. It's not the growth attenuation, it's the sterilization! (AM J BIOETHICS) Jan2010; 10 (1): 45-46; Spriggs M. Ashley's interests were not violated because she does not have the necessary interests. (AM J BIOETHICS) Jan2010; 10 (1): 52-54; Lyons B. The limits of parental authority? (AM J BIOETHICS) Jan2010; 10 (1): 50-52; Lillie T. What took so long? The disability critique recognized. (AM J BIOETHICS) Jan2010; 10 (1): 57-58. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Pediatric Care; Women's Health. NLM UID: 100898738. KW - Child Development KW - Child, Disabled -- Ethical Issues KW - Decision Making KW - Developmental Disabilities -- Ethical Issues KW - Estrogens -- Ethical Issues -- In Infancy and Childhood KW - Ethics, Medical KW - Growth -- Drug Effects -- In Infancy and Childhood KW - Hysterectomy -- Ethical Issues -- In Infancy and Childhood KW - Mastectomy -- Ethical Issues -- In Infancy and Childhood KW - Patient Rights -- In Infancy and Childhood KW - Pediatric Care -- Ethical Issues KW - Adolescence KW - Adult KW - Beneficence KW - Caregiver Burden KW - Caregivers KW - Child KW - Competence (Legal) KW - Consent KW - Courts KW - Decision Making, Clinical KW - Decision Making, Ethical KW - Decision Making, Family KW - Discrimination KW - Ethics Committees KW - Female KW - Home Nursing KW - Human Dignity KW - Motivation KW - Parents KW - Patient Advocacy KW - Patient Safety KW - Prognosis KW - Puberty, Precocious KW - Quality of Life KW - Sterilization, Sexual -- Ethical Issues KW - Uncertainty SP - 30 EP - 44 JO - American Journal of Bioethics JF - American Journal of Bioethics JA - AM J BIOETHICS VL - 10 IS - 1 CY - Oxfordshire, PB - Routledge AB - The case of Ashley X involved a young girl with profound and permanent developmental disability who underwent growth attenuation using high-dose estrogen, a hysterectomy, and surgical removal of her breast buds. Many individuals and groups have been critical of the decisions made by Ashley's parents, physicians, and the hospital ethics committee that supported the decision. While some of the opposition has been grounded in distorted facts and misunderstandings, others have raised important concerns. The purpose of this paper is to provide a brief review of the case and the issues it raised, then address 25 distinct substantive arguments that have been proposed as reasons that Ashley's treatment might be unethical. We conclude that while some important concerns have been raised, the weight of these concerns is not sufficient to consider the interventions used in Ashley's case to be contrary to her best interests, nor are they sufficient to preclude similar use of these interventions in the future for carefully selected patients who might also benefit from them. SN - 1526-5161 AD - University of Washington School of Medicine U2 - PMID: 20077335. DO - 10.1080/15265160903469336 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105291793&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105045003 T1 - Inferring predominant pathways in cellular models of breast cancer using limited sample proteomic profiling. AU - Kulkarni YM AU - Suarez V AU - Klinke DJ 2nd AU - Kulkarni, Yogesh M AU - Suarez, Vivian AU - Klinke, David J 2nd Y1 - 2010/01// N1 - Accession Number: 105045003. Language: English. Entry Date: 20110114. Revision Date: 20161116. Publication Type: journal article; research. Journal Subset: Biomedical; Europe; UK & Ireland. Special Interest: Oncologic Care. Instrumentation: Clinical Decision Making in Nursing Scale (CDMNS) (Jenkins). Grant Information: R15CA123123/CA/NCI NIH HHS/United States. NLM UID: 100967800. KW - Breast Neoplasms -- Metabolism KW - Proteomics -- Methods KW - Receptors, Cell Surface -- Metabolism KW - Proteins -- Metabolism KW - Signal Transduction -- Drug Effects KW - Tumor Markers, Biological -- Metabolism KW - Blotting, Western KW - Breast Neoplasms -- Drug Therapy KW - Cells KW - Resource Databases KW - Electrophoresis KW - Female KW - Human KW - Medicine KW - Patient Selection KW - Peptide Mapping KW - Phenotype KW - Reproducibility of Results KW - Mass Spectrometry KW - Scales SP - 291 EP - 291 JO - BMC Cancer JF - BMC Cancer JA - BMC CANCER VL - 10 PB - BioMed Central AB - Background: Molecularly targeted drugs inhibit aberrant signaling within oncogenic pathways. Identifying the predominant pathways at work within a tumor is a key step towards tailoring therapies to the patient. Clinical samples pose significant challenges for proteomic profiling, an attractive approach for identifying predominant pathways. The objective of this study was to determine if information obtained from a limited sample (i.e., a single gel replicate) can provide insight into the predominant pathways in two well-characterized breast cancer models.Methods: A comparative proteomic analysis of total cell lysates was obtained from two cellular models of breast cancer, BT474 (HER2+/ER+) and SKBR3 (HER2+/ER-), using two-dimensional electrophoresis and MALDI-TOF mass spectrometry. Protein interaction networks and canonical pathways were extracted from the Ingenuity Pathway Knowledgebase (IPK) based on association with the observed pattern of differentially expressed proteins.Results: Of the 304 spots that were picked, 167 protein spots were identified. A threshold of 1.5-fold was used to select 62 proteins used in the analysis. IPK analysis suggested that metabolic pathways were highly associated with protein expression in SKBR3 cells while cell motility pathways were highly associated with BT474 cells. Inferred protein networks were confirmed by observing an up-regulation of IGF-1R and profilin in BT474 and up-regulation of Ras and enolase in SKBR3 using western blot.Conclusion: When interpreted in the context of prior information, our results suggest that the overall patterns of differential protein expression obtained from limited samples can still aid in clinical decision making by providing an estimate of the predominant pathways that underpin cellular phenotype. SN - 1471-2407 AD - Department of Chemical Engineering, West Virginia University College of Engineering and Mineral Resources, West Virginia University, Morgantown, WV 26506, USA AD - Department of Chemical Engineering, West Virginia University College of Engineering and Mineral Resources, West Virginia University, Morgantown, WV, 26506, USA. david.klinke@mail.wvu.edu. U2 - PMID: 20550684. DO - 10.1186/1471-2407-10-291 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105045003&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104993958 T1 - Validation of cytoplasmic-to-nuclear ratio of survivin as an indicator of improved prognosis in breast cancer. AU - Rexhepaj, Elton AU - Jirstrom, Karin AU - O'Connor, Darran P AU - O'Brien, Sallyann L AU - Landberg, Goran AU - Duffy, Michael J AU - Brennan, Donal J AU - Gallagher, William M Y1 - 2010/01// N1 - Accession Number: 104993958. Language: English. Entry Date: 20110114. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Europe; UK & Ireland. Special Interest: Oncologic Care. NLM UID: 100967800. KW - Breast Neoplasms KW - Cell Nucleus KW - Cytoplasm KW - Nerve Tissue Proteins -- Analysis KW - Tumor Markers, Biological -- Analysis KW - Adult KW - Aged KW - Aged, 80 and Over KW - Algorithms KW - Breast Neoplasms -- Mortality KW - Breast Neoplasms -- Therapy KW - Chi Square Test KW - Decision Trees KW - Estrogen Receptor Modulators -- Therapeutic Use KW - Female KW - Human KW - Image Interpretation, Computer Assisted KW - Immunohistochemistry KW - Kaplan-Meier Estimator KW - Middle Age KW - Information Science KW - Predictive Value of Tests KW - Cox Proportional Hazards Model KW - Receptors, Cell Surface -- Analysis KW - Proteins -- Analysis KW - Reproducibility of Results KW - Risk Assessment KW - Risk Factors KW - Sweden KW - Tamoxifen -- Therapeutic Use KW - Time Factors KW - Tissue Array Analysis KW - Treatment Outcomes SP - 639 EP - 639 JO - BMC Cancer JF - BMC Cancer JA - BMC CANCER VL - 10 PB - BioMed Central SN - 1471-2407 AD - UCD Conway Institute, University College Dublin, Belfield, Ireland. U2 - PMID: 21092276. DO - 10.1186/1471-2407-10-639 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104993958&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105085518 T1 - Women's constructions of the 'right time' to consider decisions about risk-reducing mastectomy and risk-reducing oophorectomy. AU - Howard AF AU - Bottorff JL AU - Balneaves LG AU - Kim-Sing C AU - Howard, A Fuchsia AU - Bottorff, Joan L AU - Balneaves, Lynda G AU - Kim-Sing, Charmaine Y1 - 2010/01// N1 - Accession Number: 105085518. Language: English. Entry Date: 20110311. Revision Date: 20171109. Publication Type: journal article; research. Journal Subset: Biomedical; Europe; UK & Ireland. Special Interest: Women's Health. Grant Information: //Canadian Institutes of Health Research/Canada. NLM UID: 101088690. KW - Breast Neoplasms -- Prevention and Control KW - Decision Making KW - Mastectomy -- Psychosocial Factors KW - Ovarian Neoplasms -- Prevention and Control KW - Oophorectomy -- Psychosocial Factors KW - Adult KW - Aged KW - Aged, 80 and Over KW - Body Image KW - Breast Neoplasms KW - Breast Neoplasms -- Surgery KW - Female KW - Genes, BRCA KW - Disease Susceptibility -- Psychosocial Factors KW - Genetic Screening -- Psychosocial Factors KW - Middle Age KW - Ovarian Neoplasms KW - Ovarian Neoplasms -- Surgery KW - Behavior KW - Time Factors SP - 24 EP - 24 JO - BMC Women's Health JF - BMC Women's Health JA - BMC WOMENS HEALTH VL - 10 PB - BioMed Central AB - Background: Women who are notified they carry a BRCA1/2 mutation are presented with surgical options to reduce their risk of breast and ovarian cancer, including risk-reducing mastectomy (RRM) and risk-reducing oophorectomy (RRO). Growing evidence suggests that a sub-group of women do not make decisions about RRM and RRO immediately following genetic testing, but rather, consider these decisions years later. Women's perspectives on the timing of these decisions are not well understood. Accordingly, the purpose of this research was to describe how women construct the 'right time' to consider decisions about RRM and RRO.Methods: In-depth interviews were conducted with 22 BRCA1/2 carrier women and analyzed using qualitative, constant comparative methods.Results: The time that lapsed between receipt of genetic test results and receipt of RRM or RRO ranged from three months to nine years. The findings highlighted the importance of considering decisions about RRM and RRO one at a time. The women constructed the 'right time' to consider these decisions to be when: (1) decisions fit into their lives, (2) they had enough time to think about decisions, (3) they were ready emotionally to deal with the decisions and the consequences, (4) all the issues and conflicts were sorted out, (5) there were better options available, and (6) the health care system was ready for them.Conclusions: These findings offer novel insights relevant to health care professionals who provide decision support to women considering RRM and RRO. SN - 1472-6874 AD - School of Population and Public Health, University of British Columbia, Canada AD - School of Population and Public Health, University of British Columbia, Canada. fuchsia.howard@ubc.ca. U2 - PMID: 20687957. DO - 10.1186/1472-6874-10-24 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105085518&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105296260 T1 - Satisfaction with care among low-income women with breast cancer. AU - Thind A AU - Hoq L AU - Diamant A AU - Maly RC Y1 - 2010/01// N1 - Accession Number: 105296260. Language: English. Entry Date: 20100319. Revision Date: 20150820. Publication Type: Journal Article; questionnaire/scale; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Oncologic Care; Women's Health. Instrumentation: Physician Emotional Support Scale; Marin Acculturation Scale; Perceived Efficacy in Patient-Physician Interactions Questionnaire (PEPPI); Nurse or Staff Support Scale. Grant Information: Canada Research Chairs Program; American Cancer Society (TURSG-02-081); California Breast Cancer Research Program (7PB-0070).. NLM UID: 101159262. KW - Breast Neoplasms -- Therapy KW - Income KW - Patient Satisfaction KW - Quality of Health Care KW - Acculturation KW - Adult KW - California KW - Chi Square Test KW - Coefficient Alpha KW - Conceptual Framework KW - Cross Sectional Studies KW - Data Analysis Software KW - Female KW - Funding Source KW - Hispanics KW - Human KW - Interviews KW - Logistic Regression KW - Middle Age KW - Multiple Logistic Regression KW - Odds Ratio KW - Physician-Patient Relations KW - Questionnaires KW - Research Instruments KW - Scales KW - Self-Efficacy KW - Surveys SP - 77 EP - 86 JO - Journal of Women's Health (15409996) JF - Journal of Women's Health (15409996) JA - J WOMENS HEALTH (15409996) VL - 19 IS - 1 CY - New Rochelle, New York PB - Mary Ann Liebert, Inc. AB - Background: Patient satisfaction is an important outcome measure in determining quality of care. There are few data evaluating patient satisfaction in nonwhite, low-income populations. The objective of this study was to identify the structure, process, and outcome factors that impact patient satisfaction with care in a low-income population of women with breast cancer. Methods: In a cross-sectional survey of low-income women newly diagnosed with breast cancer, eligible women enrolled in the California Breast and Cervical Cancer Treatment Program (BCCTP) from February 2003 through September 2005 were interviewed by phone 6 months after their enrollment. This was a population-based sample of women aged >=18 years ( n = 924) with a definitive diagnosis of breast cancer and enrolled in the BCCTP. The main outcome measure was satisfaction with care received. Results: Random effects logistic regression revealed that less acculturated Latinas were more likely (odds ratio, [OR] = 5.36, p < 0.000) to be extremely satisfied with their care compared with non-Hispanic white women. Women who believed they could have been diagnosed sooner were less likely to be extremely satisfied (OR = 0.61, p < 0.000). Women who had received or were receiving radiotherapy or chemotherapy had nearly twice the odds of being extremely satisfied (OR = 2.02, p < 0.000, and OR = 2.13, p < 0.000, respectively). Greater information giving was associated with greater satisfaction (OR = 1.17, p < 0.000). Women reporting greater physician emotional support were more likely to report being extremely satisfied (OR = 1.26, p < 0.000). A higher participatory treatment decision-making score was associated with greater satisfaction (OR = 1.78, p < 0.000). Conclusions: In a low-income population, satisfaction is also reported at high levels. In addition to age, ethnicity/acculturation, receipt of chemotherapy and radiotherapy, physician emotional support, and collaborative decision making, perception of diagnostic delay is a predictor of dissatisfaction in this population. SN - 1540-9996 AD - Department of Family Medicine, Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, London . U2 - PMID: 20088662. DO - 10.1089/jwh.2009.1410 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105296260&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105284486 T1 - Development of decision-support intervention for Black women with breast cancer. AU - Sheppard VB AU - Williams KP AU - Harrison TM AU - Jennings Y AU - Lucas W AU - Stephen J AU - Robinson D AU - Mandelblatt JS AU - Taylor KL AU - Sheppard, Vanessa B AU - Williams, Karen Patricia AU - Harrison, Toni Michelle AU - Jennings, Yvonne AU - Lucas, Wanda AU - Stephen, Juleen AU - Robinson, Dana AU - Mandelblatt, Jeanne S AU - Taylor, Kathryn L Y1 - 2010/01// N1 - Accession Number: 105284486. Language: English. Entry Date: 20100402. Revision Date: 20161125. Publication Type: journal article; research. Journal Subset: Biomedical; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care; Psychiatry/Psychology. Grant Information: R01 CA127617/CA/NCI NIH HHS/United States. NLM UID: 9214524. KW - Blacks -- Psychosocial Factors KW - Breast Neoplasms -- Ethnology KW - Breast Neoplasms -- Therapy KW - Chemotherapy, Adjuvant -- Psychosocial Factors KW - Decision Making KW - Lumpectomy -- Psychosocial Factors KW - Mastectomy -- Psychosocial Factors KW - Radiotherapy, Adjuvant -- Psychosocial Factors KW - Survivors -- Psychosocial Factors KW - Adult KW - Aged KW - Attitude to Health KW - Breast Neoplasms -- Pathology KW - Breast Neoplasms -- Psychosocial Factors KW - Communication KW - Female KW - Human KW - Middle Age KW - Motivation KW - Neoplasm Staging KW - Patient Attitudes KW - Patient Education KW - Patient Satisfaction KW - Physician-Patient Relations KW - Pilot Studies KW - Spirituality KW - Support, Psychosocial SP - 62 EP - 70 JO - Psycho-Oncology JF - Psycho-Oncology JA - PSYCHO ONCOL VL - 19 IS - 1 CY - Hoboken, New Jersey PB - John Wiley & Sons, Inc. AB - Background: Adjuvant therapy improves breast cancer survival but is underutilized by Black women. Few interventions have addressed this problem. This preliminary report describes the process we used to develop a decision-support intervention for Black women eligible for adjuvant therapy. Aims were to use qualitative methods to describe factors that influence Black women's adjuvant therapy decisions, use these formative data to develop messages for a treatment decision-support intervention, and pilot test the acceptability and utility of the intervention with community members and newly diagnosed women.Methods: Thirty-four in-depth interviews were conducted with breast cancer patients in active treatment, survivors and cancer providers to gather qualitative data. Participant ages ranged from 38 to 69 years. A cultural framework was used to analyze the data and to inform intervention messages. Most women relied on their providers for treatment recommendations. Several women reported problems communicating with providers and felt unprepared to ask questions and discuss adjuvant treatment options. Other factors related to treatment experiences were: spiritual coping, collectivism and sharing breast cancer experiences with other Black survivors.Results: Using these formative data, we developed an intervention that is survivor-based and includes an in-person session which incorporates sharing personal stories, communication skills training and decision support. Intervention materials were reviewed by community members, researchers/clinicians and patients newly diagnosed with breast cancer.Conclusion: Patients reported satisfaction with the intervention and felt better prepared to talk with providers. The intervention will be tested in a randomized trial to enhance decision support and increase use of indicated adjuvant treatment. SN - 1057-9249 AD - Cancer Control Program, Georgetown University, Washington, DC 20007, USA AD - Cancer Control Program, Georgetown University, Washington, DC 20007, USA. vls3@georgetown.edu U2 - PMID: 19267384. DO - 10.1002/pon.1530 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105284486&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105290336 T1 - Informatics in radiology: comparison of logistic regression and artificial neural network models in breast cancer risk estimation. AU - Ayer T AU - Chhatwal J AU - Alagoz O AU - Kahn CE Jr AU - Woods RW AU - Burnside ES AU - Ayer, Turgay AU - Chhatwal, Jagpreet AU - Alagoz, Oguzhan AU - Kahn, Charles E Jr AU - Woods, Ryan W AU - Burnside, Elizabeth S Y1 - 2010/01//2010 Jan-Feb N1 - Accession Number: 105290336. Language: English. Entry Date: 20100416. Revision Date: 20161119. Publication Type: journal article; research. Journal Subset: Biomedical; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Diagnostic Imaging. Instrumentation: Clinical Decision Making in Nursing Scale (CDMNS) (Jenkins). Grant Information: R01 CA127379/CA/NCI NIH HHS/United States. NLM UID: 8302501. KW - Breast Neoplasms -- Radiography KW - Diagnostic Imaging -- Methods KW - Logistic Regression KW - Neural Networks (Computer) KW - Information Science -- Methods KW - Radiographic Image Interpretation, Computer-Assisted -- Methods KW - Regression KW - Female KW - Human KW - Mammography -- Methods KW - Reproducibility of Results KW - Risk Assessment -- Methods KW - Risk Factors KW - Sensitivity and Specificity KW - Scales SP - 13 EP - 22 JO - RadioGraphics JF - RadioGraphics JA - RADIOGRAPHICS VL - 30 IS - 1 CY - Oak Brook, Illinois PB - Radiological Society of North America AB - Computer models in medical diagnosis are being developed to help physicians differentiate between healthy patients and patients with disease. These models can aid in successful decision making by allowing calculation of disease likelihood on the basis of known patient characteristics and clinical test results. Two of the most frequently used computer models in clinical risk estimation are logistic regression and an artificial neural network. A study was conducted to review and compare these two models, elucidate the advantages and disadvantages of each, and provide criteria for model selection. The two models were used for estimation of breast cancer risk on the basis of mammographic descriptors and demographic risk factors. Although they demonstrated similar performance, the two models have unique characteristics-strengths as well as limitations-that must be considered and may prove complementary in contributing to improved clinical decision making. SN - 0271-5333 AD - Departments of Industrial and Systems Engineering, Radiology, and Biostatistics and Medical Informatics, University of Wisconsin, 1513 University Ave., Madison, WI 53706-1572, USA AD - Departments of Industrial and Systems Engineering, Radiology, and Biostatistics and Medical Informatics, University of Wisconsin, 1513 University Ave., Madison, WI 53706-1572, USA. U2 - PMID: 19901087. DO - 10.1148/rg.301095057 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105290336&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104907808 T1 - Implementing decision and communication aids to facilitate patient-centered care in breast cancer: A case study. AU - Belkora JK AU - Loth MK AU - Volz S AU - Rugo HS Y1 - 2009/12// N1 - Accession Number: 104907808. Language: English. Entry Date: 20110128. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Core Nursing; Europe; Health Promotion/Education; Nursing; Peer Reviewed; UK & Ireland. NLM UID: 8406280. KW - Breast Neoplasms KW - Communication KW - Decision Making KW - Patient Centered Care KW - Physician-Patient Relations KW - Female KW - Genetic Counseling KW - Attitude to Health KW - Human KW - Audiorecording SP - 360 EP - 368 JO - Patient Education & Counseling JF - Patient Education & Counseling JA - PATIENT EDUC COUNS VL - 77 IS - 3 PB - Elsevier B.V. AB - OBJECTIVE: Decision Services (DS) provide support for breast cancer patients at the University of California, San Francisco to help ensure patient-centered care. METHODS: We examined a case study to explore whether our program practices matched our program theory, and what the patient in the case thought was effective and ineffective about our decision support interventions. RESULTS: The patient relied on a decision aid to educate her husband about her condition; felt that her question list contributed to a productive and efficient consultation with her oncologist; credited an audio-recording with helping her remember to follow-up with a genetic counselor; and reviewed the consultation summary 30 days into treatment in order to reflect on her decision. The patient rated the interventions highly on surveys, and experienced desirable reductions in decisional conflict, and improvements in knowledge. However, the question-prompting intervention was associated with a small decrease in self-efficacy, and the patient criticized the decision aid for omitting mention of a prognostic test. CONCLUSION: This case illustrates how decision support interventions can be deployed to promote patient-centered care. PRACTICE IMPLICATIONS: Breast care centers should consider distributing decision aids and assisting patients in listing questions, recording consultations, and obtaining written consultation summaries. SN - 0738-3991 AD - University of California, San Francisco, United States. U2 - PMID: 19850438. DO - 10.1016/j.pec.2009.09.012 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104907808&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105249558 T1 - Putting risk prediction in perspective: relative utility curves. AU - Baker SG Y1 - 2009/11/18/ N1 - Accession Number: 105249558. Language: English. Entry Date: 20100115. Revision Date: 20150711. Publication Type: Journal Article. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Oncologic Care. NLM UID: 7503089. KW - Decision Support Techniques KW - Models, Statistical KW - Neoplasms -- Therapy KW - Predictive Value of Tests KW - ROC Curve KW - Risk Assessment KW - Breast Neoplasms -- Pathology KW - Female KW - Mathematics KW - Risk Factors SP - 1538 EP - 1542 JO - JNCI: Journal of the National Cancer Institute JF - JNCI: Journal of the National Cancer Institute JA - J NATL CANCER INST VL - 101 IS - 22 PB - Oxford University Press / USA SN - 0027-8874 AD - Biometry Research Group, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD 20892-7354, USA. sb16i@nih.gov U2 - PMID: 19843888. DO - jnci/djp353 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105249558&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105094548 T1 - Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Y1 - 2009/11/17/ N1 - Accession Number: 105094548. Corporate Author: US Preventive Services Task Force. Language: English. Entry Date: 20101210. Revision Date: 20150711. Publication Type: Journal Article; practice guidelines. Commentary: Latosinsky Steven, George Ralph, Cody 3rd Hiram S, Members of the Evidence-Based Reviews in Surgery Group. Does screening for breast cancer with five screening modalities in average-risk women reduce mortality from breast cancer? (J AM COLL SURG) Jun2013; 216 (6): 1214-1217. Journal Subset: Biomedical; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 0372351. KW - Breast Neoplasms -- Diagnosis KW - Health Screening -- Methods KW - Adult KW - Age Factors KW - Aged KW - Anxiety -- Etiology KW - Breast Neoplasms -- Mortality KW - Breast Self-Examination KW - Early Detection of Cancer KW - False Positive Results KW - Female KW - Health Care Costs KW - Magnetic Resonance Imaging -- Economics KW - Mammography -- Adverse Effects KW - Mammography -- Economics KW - Mammography -- Methods KW - Health Screening -- Economics KW - Middle Age KW - Palpation -- Economics KW - Risk Factors SP - 716 EP - 236 JO - Annals of Internal Medicine JF - Annals of Internal Medicine JA - ANN INTERN MED VL - 151 IS - 10 CY - Philadelphia, Pennsylvania PB - American College of Physicians AB - DESCRIPTION: Update of the 2002 U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening for breast cancer in the general population. METHODS: The USPSTF examined the evidence on the efficacy of 5 screening modalities in reducing mortality from breast cancer: film mammography, clinical breast examination, breast self-examination, digital mammography, and magnetic resonance imaging in order to update the 2002 recommendation. To accomplish this update, the USPSTF commissioned 2 studies: 1) a targeted systematic evidence review of 6 selected questions relating to benefits and harms of screening, and 2) a decision analysis that used population modeling techniques to compare the expected health outcomes and resource requirements of starting and ending mammography screening at different ages and using annual versus biennial screening intervals. RECOMMENDATIONS: The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take into account patient context, including the patient's values regarding specific benefits and harms. (Grade C recommendation) The USPSTF recommends biennial screening mammography for women between the ages of 50 and 74 years. (Grade B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination beyond screening mammography in women 40 years or older. (I statement) The USPSTF recommends against clinicians teaching women how to perform breast self-examination. (Grade D recommendation) The USPSTF concludes that the current evidence is insufficient to assess additional benefits and harms of either digital mammography or magnetic resonance imaging instead of film mammography as screening modalities for breast cancer. (I statement). SN - 0003-4819 U2 - PMID: 19920272. DO - 10.1059/0003-4819-151-10-200911170-00008 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105094548&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105241349 T1 - Clinical practice patterns and cost effectiveness of human epidermal growth receptor 2 testing strategies in breast cancer patients. AU - Phillips KA AU - Marshall DA AU - Haas JS AU - Elkin EB AU - Liang SY AU - Hassett MJ AU - Ferrusi I AU - Brock JE AU - Van Bebber SL AU - Phillips, Kathryn A AU - Marshall, Deborah A AU - Haas, Jennifer S AU - Elkin, Elena B AU - Liang, Su-Ying AU - Hassett, Michael J AU - Ferrusi, Ilia AU - Brock, Jane E AU - Van Bebber, Stephanie L Y1 - 2009/11/15/ N1 - Accession Number: 105241349. Language: English. Entry Date: 20100115. Revision Date: 20161125. Publication Type: journal article; research. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Oncologic Care. Grant Information: R01 CA101849/CA/NCI NIH HHS/United States. NLM UID: 0374236. KW - Antibodies, Monoclonal -- Economics KW - Antineoplastic Agents -- Therapeutic Use KW - Breast Neoplasms -- Drug Therapy KW - Breast Neoplasms -- Economics KW - Breast Neoplasms -- Metabolism KW - Cost Benefit Analysis KW - Drug Delivery Systems -- Economics KW - Practice Patterns -- Economics KW - Receptors, Cell Surface -- Analysis KW - Tumor Markers, Biological -- Analysis KW - Antibodies, Monoclonal -- Therapeutic Use KW - Antineoplastic Agents -- Economics KW - Drug Delivery Systems -- Statistics and Numerical Data SP - 5166 EP - 5174 JO - Cancer (0008543X) JF - Cancer (0008543X) JA - CANCER VL - 115 IS - 22 CY - Hoboken, New Jersey PB - John Wiley & Sons, Inc. AB - Background: Testing technologies are increasingly used to target cancer therapies. Human epidermal growth factor receptor 2 (HER2) testing to target trastuzumab for patients with breast cancer provides insights into the evidence needed for emerging testing technologies.Methods: The authors reviewed literature on HER2 test utilization and cost effectiveness of HER2 testing for patients with breast cancer. They examined available evidence on: percentage of eligible patients tested for HER2; test methods used; concordance of test results between community and central/reference laboratories; use of trastuzumab by HER2 test result; and cost effectiveness of testing strategies.Results: Little evidence was available to determine whether all eligible patients are tested, how many are retested to confirm results, and how many with negative HER2 test results still receive trastuzumab. Studies suggested that up to 66% of eligible patients had no documentation of testing in claims records, up to 20% of patients receiving trastuzumab were not tested or had no documentation of a positive test, and 20% of HER2 results may be incorrect. Few cost-effectiveness analyses of trastuzumab explicitly considered the economic implications of various testing strategies.Conclusions: There was little information about the actual use of HER2 testing in clinical practice, but evidence suggested important variations in testing practices and key gaps in knowledge exist. Given the increasing use of targeted therapies, it is critical to build an evidence base that supports informed decision making on emerging testing technologies in cancer care. SN - 0008-543X AD - Department of Clinical Pharmacy, University of California San Francisco, San Francisco, CA 94143-0613, USA AD - Department of Clinical Pharmacy, University of California-San Francisco, San Francisco, California. U2 - PMID: 19753618. DO - 10.1002/cncr.24574 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105241349&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105262037 T1 - Current practices and perspectives on breast cancer screening and treatment in older women with dementia. AU - Smyth KA Y1 - 2009/11/02/Nov2009 Supplement 2 N1 - Accession Number: 105262037. Language: English. Entry Date: 20100129. Revision Date: 20150711. Publication Type: Journal Article; research. Supplement Title: Nov2009 Supplement 2. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Gerontologic Care; Oncologic Care. Grant Information: National Cancer Institute; National Institute on Aging (Grant P20 CA103736); Aging and Cancer Research Program; Case Comprehensive Cancer Center; Case Western Reserve University; and National Institute on Aging Alzheimer's Disease Centers Program (P50AG08012). NLM UID: 7503062. KW - Alzheimer's Disease KW - Breast Neoplasms -- Diagnosis -- In Old Age KW - Breast Neoplasms -- Therapy -- In Old Age KW - Cancer Screening -- In Old Age KW - Caregivers KW - Decision Making KW - Dementia KW - Health Beliefs KW - Aged KW - Female KW - Funding Source KW - Human KW - Male KW - Middle Age KW - Pilot Studies KW - Qualitative Studies KW - Semi-Structured Interview KW - Thematic Analysis SP - S272 EP - 4 JO - Journal of the American Geriatrics Society JF - Journal of the American Geriatrics Society JA - J AM GERIATR SOC VL - 57 CY - Malden, Massachusetts PB - Wiley-Blackwell AB - OBJECTIVES: To explore the nature of breast cancer screening and treatment decisions in older women with dementia.DESIGN: Thematic analysis of semistructured telephone interviews.SETTING: Alzheimer's Disease Research Center Registry.PARTICIPANTS: Twenty-three family caregivers (CGs) of women with dementia (WWD).MEASUREMENTS: Semistructured questions regarding CGs' perceptions of current and predementia beliefs held by the WWD about the importance of regular screening mammograms, CGs' views about the importance of obtaining regular screening mammograms for the WWD and whether dementia stage of the WWD influenced these views, and CGs' view of what level of treatment would be appropriate if WWD they were caring for were to be diagnosed with breast cancer.RESULTS: In CGs of women with mild to moderate (but not severe) dementia, mammogram importance ratings reflected perceived predementia importance levels (generally high). Most CGs of women with mild to moderate dementia planned to continue screening regardless of dementia severity of the WWD, but CGs of women with severe dementia at the time of the interview did not generally consider screening important. Physician recommendations were frequently found to influence screening practices. CGs' views on appropriate treatment if the WWD developed breast cancer varied widely except in the case of severe dementia, in which case comfort care was consistently preferred.CONCLUSION: Breast cancer screening and treatment in dementia are active areas for healthcare decision-making, and supportive interventions involving physicians, CGs, and WWD are needed. SN - 0002-8614 AD - Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, Ohio 44106-4945; kathleen.smyth@case.edu U2 - PMID: 20122028. DO - 10.1111/j.1532-5415.2009.02510.x UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105262037&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105236887 T1 - Adjuvant! When the new world meets the old world. AU - Huober J AU - Thürlimann B Y1 - 2009/11// N1 - Accession Number: 105236887. Language: English. Entry Date: 20100115. Revision Date: 20150711. Publication Type: Journal Article; commentary; letter. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care. NLM UID: 100957246. KW - Antineoplastic Agents -- Therapeutic Use KW - Breast Neoplasms -- Drug Therapy KW - Decision Support Techniques KW - Models, Biological KW - Online Systems -- Standards KW - Patient Selection KW - Breast Neoplasms -- Diagnosis KW - Breast Neoplasms -- Ethnology KW - Breast Neoplasms -- Mortality KW - Calibration KW - Chemotherapy, Adjuvant KW - Discriminant Analysis KW - Prognosis KW - Europe KW - Female KW - Internet KW - Practice Guidelines KW - Predictive Value of Tests KW - Reproducibility of Results KW - Risk Assessment KW - Time Factors KW - Treatment Outcomes KW - United States SP - 1028 EP - 1029 JO - Lancet Oncology JF - Lancet Oncology JA - LANCET ONCOL VL - 10 IS - 11 CY - New York, New York PB - Elsevier B.V. SN - 1470-2045 U2 - PMID: 19880058. DO - 10.1016/S1470-2045(09)70323-7 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105236887&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105236884 T1 - Calibration and discriminatory accuracy of prognosis calculation for breast cancer with the online Adjuvant! program: a hospital-based retrospective cohort study. AU - Mook S AU - Schmidt MK AU - Rutgers EJ AU - van de Velde AO AU - Visser O AU - Rutgers SM AU - Armstrong N AU - Van't Veer LJ AU - Ravdin PM Y1 - 2009/11// N1 - Accession Number: 105236884. Language: English. Entry Date: 20100115. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care. NLM UID: 100957246. KW - Antineoplastic Agents -- Therapeutic Use KW - Breast Neoplasms -- Drug Therapy KW - Breast Neoplasms -- Mortality KW - Decision Support Techniques KW - Discriminant Analysis KW - Models, Biological KW - Online Systems -- Standards KW - Patient Selection KW - Adult KW - Age Factors KW - Aged KW - Breast Neoplasms -- Diagnosis KW - Breast Neoplasms KW - Calibration KW - Chemotherapy, Adjuvant KW - Prognosis KW - Female KW - Hospitalization KW - Human KW - Internet KW - Kaplan-Meier Estimator KW - Neoplasm Metastasis KW - Middle Age KW - Neoplasm Staging KW - Netherlands KW - Practice Guidelines KW - Predictive Value of Tests KW - Cox Proportional Hazards Model KW - Proteins -- Analysis KW - Data Collection KW - Reproducibility of Results KW - Retrospective Design KW - Risk Assessment KW - Time Factors KW - Treatment Outcomes SP - 1070 EP - 1076 JO - Lancet Oncology JF - Lancet Oncology JA - LANCET ONCOL VL - 10 IS - 11 CY - New York, New York PB - Elsevier B.V. AB - BACKGROUND: Adjuvant! is a web-based program that calculates individualised 10-year survival probabilities and predicted benefit of adjuvant systemic therapy. The Adjuvant! model has not been validated in any large European series. The aim of our study was to validate Adjuvant! in Dutch patients, investigating both its calibration and discriminatory accuracy. METHODS: Patients who were at least partly treated at the Netherlands Cancer Institute for breast cancer between 1987 and 1998 were included if they met the following criteria: tumour size T1 (5 cm), invasive breast carcinoma, with information about involvement of axillary lymph nodes available, no distant metastases, primary surgery, axillary staging, and radiotherapy according to national guidelines. Clinicopathological characteristics and adjuvant treatment data were retrieved from hospital records and medical registries and were entered into the Adjuvant! (version 8.0) batch processor with blinding to outcome. Endpoints were overall survival and the proportion of patients that did not die from breast cancer (breast-cancer-specific survival [BCSS]). FINDINGS: 5380 patients were included with median follow-up of 11.7 years (range 0.03-21.8). The 10-year observed overall survival (69.0%) and BCSS (78.6%) and Adjuvant! predicted overall survival (69.1%) and BCSS (77.8%) were not statistically different (p=0.87 and p=0.18, respectively). Moreover, differences between predicted and observed outcomes were within 2% for most relevant clinicopathological subgroups. In patients younger than 40 years, Adjuvant! overestimated overall survival by 4.2% (p=0.04) and BCSS by 4.7% (p=0.01). The concordance index, which indicates discriminatory accuracy at the individual level, was 0.71 for BCSS in the entire cohort. INTERPRETATION: Adjuvant! accurately predicted 10-year outcomes in this large-scale Dutch validation study and is of use for adjuvant treatment decision making, although the results may be less reliable in some subgroups. FUNDING: Dutch National Genomics Initiative-Cancer Genomics Center, Dutch Cancer Society-KWF. SN - 1470-2045 AD - Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands. U2 - PMID: 19801202. DO - 10.1016/S1470-2045(09)70254-2 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105236884&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105329641 T1 - Electronic health records and the management of women at high risk of hereditary breast and ovarian cancer. AU - Drohan B AU - Ozanne EM AU - Hughes KS Y1 - 2009/09/02/Sep/Oct2009 Suppleme N1 - Accession Number: 105329641. Language: English. Entry Date: 20091204. Revision Date: 20150711. Publication Type: Journal Article; tables/charts. Supplement Title: Sep/Oct2009 Suppleme. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Peer Reviewed; USA. Special Interest: Informatics; Oncologic Care; Women's Health. NLM UID: 9505539. KW - Breast Neoplasms -- Familial and Genetic KW - Breast Neoplasms -- Risk Factors KW - Electronic Health Records KW - Decision Making, Clinical KW - Ovarian Neoplasms -- Familial and Genetic KW - Ovarian Neoplasms -- Risk Factors KW - Data Analysis KW - Decision Support Systems, Clinical KW - Family History KW - Female SP - S46 EP - 55 JO - Breast Journal JF - Breast Journal JA - BREAST J VL - 15 CY - Malden, Massachusetts PB - Wiley-Blackwell AB - Currently, management strategies exist that can decrease the morbidity and mortality associated with having a BRCA1 or BRCA2 mutation. Unfortunately, the task of identifying these patients at high risk is a daunting challenge. This problem is intensified because Electronic Health Records (EHRs) today lack the functionality needed to identify these women and to manage those women once they have been identified. Numerous niche software programs have been developed to fill this gap. Unfortunately, these extremely valuable niche programs are prevented from being interoperable with the EHRs, on the premise that each EHR vendor will build their own programs. Effectively, in our efforts to adopt EHRs, we have lost sight of the fact that they can only have a major impact on quality of care if they contain structured data and if they interact with robust Clinical Decision Support (CDS) tools. We are at a cross roads in the development of the health care Information Technology infrastructure. We can choose a path where each EHR vendor develops each CDS module independently. Alternatively, we can choose a path where experts in each field develop external niche software modules that are interoperable with any EHR vendor. We believe that the modular approach to development of niche software programs that are interoperable with current EHRs will markedly increase the speed at which useful and functional EHRs that improve quality of care become a reality. Thus, in order to realize the benefits of CDS, we suggest vendors develop means to become interoperable with external modular niche programs. SN - 1075-122X AD - Department of Computer Science, University of Massachusetts Lowell, Massachusetts UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105329641&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105440160 T1 - Cognitive and emotional factors predicting decisional conflict among high-risk breast cancer survivors who receive uninformative BRCA1/2 results. AU - Rini C AU - O'Neill SC AU - Valdimarsdottir H AU - Goldsmith RE AU - Jandorf L AU - Brown K AU - DeMarco TA AU - Peshkin BN AU - Schwartz MD Y1 - 2009/09// N1 - Accession Number: 105440160. Language: English. Entry Date: 20091023. Revision Date: 20150711. Publication Type: Journal Article; pictorial; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Oncologic Care; Psychiatry/Psychology. Instrumentation: Brief Symptom Inventory (BSI) (Derogatis et al); Impact of Events Scale (IES); Multidimensional Impact of Cancer Risk Assessment Questionnaire (Cella et al). Grant Information: Funded by the National Cancer Institute, Grants R01 CA 82346 and K07 CA104701. NLM UID: 8211523. KW - Breast Neoplasms KW - Conflict (Psychology) KW - Decision Making, Patient KW - Genetic Screening -- Psychosocial Factors KW - Stress, Psychological KW - Adult KW - Brief Symptom Inventory KW - Cancer Survivors -- Psychosocial Factors KW - Clinical Assessment Tools KW - Descriptive Statistics KW - Emotions KW - Female KW - Funding Source KW - Genes, BRCA KW - Health Beliefs KW - Impact of Events Scale KW - Mastectomy KW - Middle Age KW - Multiple Regression KW - Paired T-Tests KW - Patient Attitudes KW - Prospective Studies KW - Time Factors KW - Women KW - Human SP - 569 EP - 578 JO - Health Psychology JF - Health Psychology JA - HEALTH PSYCHOL VL - 28 IS - 5 CY - Washington, District of Columbia PB - American Psychological Association AB - OBJECTIVE: To investigate high-risk breast cancer survivors' risk reduction decision making and decisional conflict after an uninformative BRCA1/2 test. DESIGN: Prospective, longitudinal study of 182 probands undergoing BRCA1/2 testing, with assessments 1-, 6-, and 12-months postdisclosure. MEASURES: Primary predictors were health beliefs and emotional responses to testing assessed 1-month postdisclosure. Main outcomes included women's perception of whether they had made a final risk management decision (decision status) and decisional conflict related to this issue. RESULTS: There were four patterns of decision making, depending on how long it took women to make a final decision and the stability of their decision status across assessments. Late decision makers and nondecision makers reported the highest decisional conflict; however, substantial numbers of women--even early and intermediate decision makers--reported elevated decisional conflict. Analyses predicting decisional conflict 1- and 12-months postdisclosure found that, after accounting for control variables and decision status, health beliefs and emotional factors predicted decisional conflict at different timepoints, with health beliefs more important 1 month after test disclosure and emotional factors more important 1 year later. CONCLUSION: Many of these women may benefit from decision making assistance. © American Psychological Association SN - 0278-6133 AD - Department of Oncological Sciences, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1130, New York, NY 10021, USA. christine.rini@mssm.edu U2 - PMID: 19751083. DO - 10.1037/a0015205 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105440160&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105418502 T1 - Consumer empowerment through metadata-based information quality reporting: The Breast Cancer Knowledge Online Portal. AU - McKemmish S AU - Manaszewicz R AU - Burstein F AU - Fisher J Y1 - 2009/09// N1 - Accession Number: 105418502. Language: English. Entry Date: 20091002. Revision Date: 20150820. Publication Type: Journal Article; pictorial; research; tables/charts. Journal Subset: Computer/Information Science; Peer Reviewed; USA. Special Interest: Informatics. Grant Information: Australian Research Council Linkage Grant (2002-2003). NLM UID: 101087008. KW - Breast Neoplasms KW - Consumer Health Information KW - Internet KW - Metadata KW - Adult KW - Aged KW - Funding Source KW - Information Needs KW - Information Seeking Behavior KW - Metadata -- Standards KW - Middle Age KW - Trust KW - Website Development KW - Human SP - 1792 EP - 1807 JO - Journal of the American Society for Information Science & Technology JF - Journal of the American Society for Information Science & Technology JA - J AM SOC INF SCI TECHNOL VL - 60 IS - 9 CY - Hoboken, New Jersey PB - John Wiley & Sons, Inc. AB - Consumer empowerment and the role of the expert patient in their own healthcare, enabled through timely access to quality information, have emerged as significant factors in better health and lifestyle outcomes. Governments, medical researchers, healthcare providers in the public and private sector, drug companies, health consumer groups, and individuals are increasingly looking to the Internet to both access and distribute health information, communicate with each other, and form supportive or collaborative online communities. Evaluating the accuracy, provenance, authority, and reliability of Web-based health information is a major priority. The Breast Cancer Knowledge Online Portal project (BCKOnline) explored the individual and changing information and decision support needs of women with breast cancer and the issues they face when searching for relevant and reliable health information on the Internet. Its user-sensitive research design integrated multidisciplinary methods including user information-needs analysis, knowledge-domain mapping, metadata modeling, and systems-development research techniques. The main outcomes were a personalized information portal driven by a metadata repository of user-sensitive resource descriptions, the BCKOnline Metadata Schema, richer understandings of the concepts of quality, relevance, and reliability, and a user-sensitive design methodology. This article focuses on the innovative, metadata-based quality reporting feature of the BCKOnline Portal, and concludes that it is timely to consider the inclusion of quality elements in resource discovery metadata schema, especially in the health domain. SN - 1532-2882 AD - Faculty of Information Technology, Monash University, P.O. Box 97, Caulfield East, Victoria, 3145 Australia UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105418502&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105327824 T1 - Incorporating extrinsic goals into decision and cost-effectiveness analyses. AU - Hazen GB AU - Schwartz A Y1 - 2009/09//Sep/Oct2009 N1 - Accession Number: 105327824. Language: English. Entry Date: 20091211. Revision Date: 20150711. Publication Type: Journal Article; equations & formulas; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 8109073. KW - Cost Benefit Analysis KW - Decision Making, Clinical -- Evaluation KW - Goal-Setting KW - Patients -- Psychosocial Factors KW - Quality of Life -- Evaluation KW - Breast Neoplasms -- Prevention and Control KW - Female KW - Male KW - Surgery, Operative KW - Survival SP - 580 EP - 589 JO - Medical Decision Making JF - Medical Decision Making JA - MED DECIS MAKING VL - 29 IS - 5 CY - Thousand Oaks, California PB - Sage Publications Inc. AB - It has not been widely recognized that medical patients as individuals may have goals that are not easily expressed in terms of quality-adjusted life years (QALYs). The QALY model deals with ongoing goals such as reducing pain or maintaining mobility, but goals such as completing an important project or seeing a child graduate from college occur at unique points in time and do not lend themselves to easy expression in terms of QALYs. Such extrinsic goals have been posited as explanations for preferences inconsistent with the QALY model, such as unwillingness to trade away time or accept gambles. In this article, the authors examine methods for including extrinsic goals in medical decision and cost-effectiveness analyses. As illustrations, they revisit 2 previously published analyses, the management of unruptured intracranial arteriovenous malformations (A VMs) and the evaluation of preventive strategies for BRCA + women. SN - 0272-989X AD - Department of Industrial Engineering and Management Sciences, Northwestern University, Evanston, Illinois U2 - PMID: 19329774. DO - 10.1177/0272989X09333121 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105327824&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105428877 T1 - In the moment: women speak about surgical treatment decision making days after a breast cancer diagnosis. AU - Lally RM Y1 - 2009/09// N1 - Accession Number: 105428877. Language: English. Entry Date: 20091023. Revision Date: 20150819. Publication Type: Journal Article; research; tables/charts. Journal Subset: Core Nursing; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Nursing; Peer Reviewed; USA. Special Interest: Oncologic Care. Grant Information: Funded by an ONS Foundation Nursing Research Grant, a Midwest Nursing Research Society Dissertation Research Grant, the Helen Wells Nursing Research Award, a Doctoral Dissertation Grant, and the Violet Shea Nursing Scholarship Fund through the University of Minnesota Nursing and Graduate Schools. NLM UID: 7809033. KW - Breast Neoplasms -- Surgery KW - Cancer Patients KW - Decision Making, Patient KW - Mastectomy KW - Adult KW - Age Factors KW - Aged KW - Aged, 80 and Over KW - Audiorecording KW - Content Analysis KW - Descriptive Research KW - Female KW - Funding Source KW - Grounded Theory KW - Lumpectomy KW - Mental Processes KW - Middle Age KW - Midwestern United States KW - Patient Attitudes -- Evaluation KW - Preoperative Period KW - Professional-Patient Relations KW - Semi-Structured Interview KW - Human SP - E257 EP - 65 JO - Oncology Nursing Forum JF - Oncology Nursing Forum JA - ONCOL NURS FORUM VL - 36 IS - 5 CY - Pittsburgh, Pennsylvania PB - Oncology Nursing Society AB - PURPOSE/OBJECTIVES: To explore the pretreatment thoughts and behaviors of women newly diagnosed with breast cancer regarding their surgical treatment decision-making experience. RESEARCH APPROACH: Qualitative, descriptive. SETTING: A multispecialty breast center in the midwestern region of the United States. PARTICIPANTS: 18 English-speaking women, aged 37-87 years, mean of 12 days postdiagnosis of clinical stage 0-11 breast cancer. METHODOLOGIC APPROACH: Open to semistructured interviews were conducted during the period following surgical consultation but prior to surgical treatment. Transcribed interviews, originally analyzed to identify the psychological processes of women in response to breast cancer diagnosis, were additionally analyzed using directed content analysis focusing on women's thoughts and behaviors related to their surgical treatment decision-making process. MAIN RESEARCH VARIABLES: Breast cancer surgery and decision making pretreatment. FINDINGS: Women's pretreatment thoughts and behaviors related to surgical treatment decision making were characterized by information processing, contemplating options, and interacting with others. Breast cancer information was used by women before the surgical consultation and after treatment decisions had been made. Treatment options were contemplated and preferences formed often before the initial surgical consultation. Women associated having options with a better prognosis. Age was a factor primarily in the type of information women desired. CONCLUSIONS: Most women made their own surgical treatment decisions with ease, supported by the confidence instilled by their surgeons and oncology nurses. INTERPRETATION: The findings provide oncology nurses with insight regarding women's desire for and use of information and their contemplation of surgical options, therefore suggesting areas on which to focus clinical assessment and to test tailored interventions. SN - 0190-535X AD - School of Nursing, University of Buffalo, NY; rmlally@buffalo.edu U2 - PMID: 19726385. DO - 10.1188/09.ONF.E257-E265 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105428877&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105352141 T1 - Expression of the Breast Cancer Metastasis Suppressor 1 (BRMS1) maintains in vitro chemosensitivity of breast cancer cells. AU - Vaidya KS AU - Sanchez JJ AU - Kim EL AU - Welch DR AU - Vaidya, Kedar S AU - Sanchez, Jesus J AU - Kim, Eun Lim AU - Welch, Danny R Y1 - 2009/08/18/ N1 - Accession Number: 105352141. Language: English. Entry Date: 20090717. Revision Date: 20161129. Publication Type: journal article; research. Journal Subset: Biomedical; Europe; UK & Ireland. Special Interest: Oncologic Care. Grant Information: R01-CA87728/CA/NCI NIH HHS/United States. NLM UID: 7600053. KW - Adenocarcinoma -- Pathology KW - Antineoplastic Agents -- Pharmacodynamics KW - Breast Neoplasms -- Pathology KW - Drug Resistance, Neoplasm KW - Proteins -- Physiology KW - Cell Physiology -- Drug Effects KW - Cells -- Drug Effects KW - Cells -- Metabolism KW - Cells -- Pathology KW - Colony-Forming Units Assay KW - Doxorubicin -- Pharmacodynamics KW - Female KW - Fluorouracil -- Pharmacodynamics KW - Genes -- Drug Effects KW - Paclitaxel -- Pharmacodynamics KW - Phosphatases KW - Proteins KW - Recombinant Proteins -- Physiology KW - Transferases KW - Vincristine -- Pharmacodynamics SP - 100 EP - 107 JO - Cancer Letters JF - Cancer Letters JA - CANCER LETT VL - 281 IS - 1 PB - Elsevier B.V. AB - The Breast Cancer Metastasis Suppressor 1 (BRMS1) belongs to an expanding category of proteins called metastasis suppressors that demonstrate in vivo metastasis suppression while still allowing growth of the orthotopic tumor. Since BRMS1 decreases either the expression or function of multiple mediators implicated in resistance to chemotherapy (NF-kappaB, AKT, EGFR), we asked whether breast carcinoma cells expressing BRMS1 could be sensitized upon exposure to commonly used therapeutic agents that inhibit some of these same cellular mediators as BRMS1. In this report, we demonstrate that chemosensitivity of breast cancer cells is preserved in the presence of BRMS1. Further, BRMS1 does not change expression of AKT isoforms or PTEN, implicated in chemoresistance to common drug agents. Overall, our data with two different metastatic breast cancer cell lines indicates that BRMS1 expression status may not interfere with the response to commonly used chemotherapeutic agents in the management of solid tumors such as breast cancer. Since tumor protein expression analysis increasingly guides therapy decisions, our data may be of clinical benefit in disease management including profiling for BRMS1 expression before start of therapy. SN - 0304-3835 AD - Department of Pathology, The University of Alabama at Birmingham, 35294-0019, USA AD - Department of Pathology, The University of Alabama at Birmingham, Birmingham, AL 35294-0019, United States. U2 - PMID: 19307053. DO - 10.1016/j.canlet.2009.02.035 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105352141&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105246894 T1 - Breast screening overdiagnosis. Consensus and decision aids. AU - Barratt AL Y1 - 2009/08/15/ N1 - Accession Number: 105246894. Language: English. Entry Date: 20100108. Revision Date: 20150711. Publication Type: Journal Article; letter. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. NLM UID: 101090866. KW - Breast Neoplasms -- Diagnosis KW - Health Screening -- Methods KW - Female KW - Mammography -- Methods KW - Patient Care -- Methods SP - b3260 EP - b3260 JO - BMJ: British Medical Journal (Overseas & Retired Doctors Edition) JF - BMJ: British Medical Journal (Overseas & Retired Doctors Edition) JA - BMJ BR MED J (OVERSEAS & RETIRED DOCTORS ED) VL - 339 IS - 7717 PB - BMJ Publishing Group SN - 1759-2151 U2 - PMID: 19671608. DO - 10.1136/bmj.b3260 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105246894&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105363282 T1 - Are patients getting the "gist" in risk communication? Patient understanding of prognosis in breast cancer treatment. AU - Hutton DW AU - Belkora JK AU - Shachter RD AU - Moore DH AU - Hutton, David W AU - Belkora, Jeffrey K AU - Shachter, Ross D AU - Moore, Dan H Y1 - 2009/07//Jul-Sep2009 N1 - Accession Number: 105363282. Language: English. Entry Date: 20090828. Revision Date: 20171115. Publication Type: journal article; pictorial; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Health Promotion/Education; Peer Reviewed; USA. Special Interest: Oncologic Care. Grant Information: 9K12HD052163-06/HD/NICHD NIH HHS/United States. NLM UID: 8610343. KW - Breast Neoplasms -- Mortality KW - Breast Neoplasms -- Prognosis KW - Cancer Patients -- Education KW - Communication KW - Decision Making, Patient KW - Oncologic Care KW - Adult KW - Aged KW - California KW - Cancer Care Facilities KW - Chemotherapy, Cancer KW - Coefficient Alpha KW - Decision Support Techniques KW - Descriptive Statistics KW - Educational Status KW - Employment Status KW - Female KW - Funding Source KW - Health Knowledge KW - Hormone Therapy KW - Marital Status KW - McNemar's Test KW - Middle Age KW - Mortality KW - Pilot Studies KW - Secondary Analysis KW - Software KW - Surveys KW - Vignettes KW - Human SP - 194 EP - 199 JO - Journal of Cancer Education JF - Journal of Cancer Education JA - J CANCER EDUC VL - 24 IS - 3 CY - , PB - Springer Science & Business Media B.V. AB - Background: Many oncologists consult the Adjuvant! prognostic model to communicate risk with breast cancer patients; however, little is known about how effective that communication is.Methods: The authors analyzed this small data set featuring 20 breast cancer patients' risk estimates, focusing on rankings or gist of the estimates.Results: Overall, there was no gain in the accuracy of patient rankings. The number of patients with more accurate estimates was matched by the number of patients with less accurate estimates after consultation.Conclusions: The current methods used by oncologists to present Adjuvant! risks were not effective in helping patients to get the gist of their risks. SN - 0885-8195 AD - Department of Management Science and Engineering, Stanford University, Stanford, CA, USA AD - Department of Management Science and Engineering, Stanford University, Stanford, CA, USA. david.hutton@stanfordalumni.org U2 - PMID: 19526406. DO - 10.1080/08858190902876452 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105363282&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105402156 T1 - Long-term health outcomes of a decision aid: data from a randomized trial of Adjuvant! in women with localized breast cancer. AU - Vickers AJ AU - Elkin EB AU - Peele PB AU - Dickler M AU - Siminoff LA Y1 - 2009/07//Jul/Aug2009 N1 - Accession Number: 105402156. Language: English. Entry Date: 20091016. Revision Date: 20150711. Publication Type: Journal Article; clinical trial; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Oncologic Care; Women's Health. Grant Information: Funded by the National Cancer Institute. NLM UID: 8109073. KW - Breast Neoplasms -- Therapy KW - Decision Making, Patient KW - Decision Support Techniques KW - Survival KW - Aged KW - Clinical Trials KW - Confidence Intervals KW - Data Analysis Software KW - Data Analysis, Statistical KW - Descriptive Statistics KW - Female KW - Fisher's Exact Test KW - Funding Source KW - Middle Age KW - P-Value KW - Human SP - 461 EP - 467 JO - Medical Decision Making JF - Medical Decision Making JA - MED DECIS MAKING VL - 29 IS - 4 CY - Thousand Oaks, California PB - Sage Publications Inc. AB - PURPOSE: Women with localized breast cancer face difficult decisions about adjuvant therapy. Several decision aids are available to help women choose between treatment options. Decision aids are known to affect treatment choices and may therefore affect patient survival. The authors aimed to model the effects of the Adjuvant! decision aid on expected survival in women with early stage breast cancer. Patients and METHODS: . Data were obtained from a randomized trial of Adjuvant! (n = 395). To calculate the effects of the decision aid on survival, the authors used the Adjuvant! survival predictions as a surrogate endpoint. Data from each arm were entered separately into statistical models to estimate change in survival associated with receiving the Adjuvant! decision aid. RESULTS: . Most women ( 85%) chose a treatment option that maximized predicted survival. The effects of the decision aid on outcome could not be modeled because a small number of women (n = 12, 3%) chose treatment options associated with a large (5%-14%) loss in survival. These women-most typically estrogen receptor positive but refusing hormonal therapy-were equally divided between Adjuvant! and control groups and were not distinguished by medical or demographic factors. CONCLUSIONS: . Expected benefit from treatment is a key variable in understanding patient behavior. A small number of women refuse adjuvant treatment associated with large increases in predicted survival, even when they are explicitly informed about the degree of benefit they would forgo. Investigation of the effects of decision aids on cancer survival is unlikely to be fruitful due to power considerations. SN - 0272-989X AD - Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York. vickersa@mskcc.org. U2 - PMID: 19270108. DO - 10.1177/0272989X08329344 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105402156&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105402157 T1 - Is there a role for decision aids in advanced breast cancer? AU - Sepucha KR AU - Ozanne EM AU - Partridge AH AU - Moy B Y1 - 2009/07//Jul/Aug2009 N1 - Accession Number: 105402157. Language: English. Entry Date: 20091016. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Oncologic Care; Women's Health. Instrumentation: Decisional Conflict Scale; Control Preferences Scale [modified]. Grant Information: Lance Armstrong Foundation. NLM UID: 8109073. KW - Breast Neoplasms -- Therapy KW - Decision Support Techniques -- Utilization KW - Neoplasm Metastasis -- Therapy KW - Adult KW - Aged KW - Confidence Intervals KW - Descriptive Statistics KW - Female KW - Funding Source KW - Kappa Statistic KW - Massachusetts KW - McNemar's Test KW - Middle Age KW - P-Value KW - Paired T-Tests KW - Pilot Studies KW - Pretest-Posttest Design KW - Record Review KW - Scales KW - Surveys KW - Human SP - 475 EP - 482 JO - Medical Decision Making JF - Medical Decision Making JA - MED DECIS MAKING VL - 29 IS - 4 CY - Thousand Oaks, California PB - Sage Publications Inc. AB - BACKGROUND: To pilot test a decision aid (DA) for advanced BC. DESIGN: . Pretest, posttest study. Setting. Two academic cancer centers in Boston, Massachusetts. Patients. Fifty patients diagnosed with advanced BC. Intervention. A patient DA that consisted of a 30-minute DVD and booklet. Measurements . Patients were surveyed at baseline, after the intervention, and at 3 months. MEASURES: included use and acceptability of DA, distress, treatment goals, and preference for and actual participation in decisions. Physicians were surveyed at baseline and 3 months. Measures included treatment goals, assessment of patients' experience with treatments, and patients' preference for and actual participation in decisions. RESULTS: . Thirty-two patients (64%) enrolled and completed the baseline survey, 30 completed the postvideo survey, and 25 completed the 3-month survey. The DA was acceptable and did not increase distress. The majority desired to share decision making with their doctor. Only 38% achieved their desired level of participation. At baseline, agreement between patients and providers on the main goal of treatment (lengthen life v. relieve symptoms) was 50% (kappa = -0.045, P = 0.71), and at 3 months it was 74% (kappa = 0.125, P = 0.48). CONCLUSIONS: . It is feasible to perform a clinical trial of a DA with advanced BC patients. Most participants wanted to participate in decisions about their care and found the DA acceptable. This study highlights several issues in developing and implementing DAs in this vulnerable population facing complex decisions. SN - 0272-989X AD - Health Decision Research Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. ksepucha@partners.org. U2 - PMID: 19329775. DO - 10.1177/0272989X09333124 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105402157&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105353365 T1 - Factors influencing changes in employment among women with newly diagnosed breast cancer. AU - Hassett MJ AU - O'Malley AJ AU - Keating NL AU - Hassett, Michael J AU - O'Malley, A James AU - Keating, Nancy L Y1 - 2009/06/15/ N1 - Accession Number: 105353365. Language: English. Entry Date: 20090807. Revision Date: 20161125. Publication Type: journal article; research. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Oncologic Care. Grant Information: R25 CA092203/CA/NCI NIH HHS/United States. NLM UID: 0374236. KW - Breast Neoplasms -- Drug Therapy KW - Breast Neoplasms -- Radiotherapy KW - Employment KW - Adult KW - Age Factors KW - Antineoplastic Agents -- Adverse Effects KW - Female KW - Middle Age KW - Risk Factors KW - Time Factors KW - Treatment Outcomes SP - 2775 EP - 2782 JO - Cancer (0008543X) JF - Cancer (0008543X) JA - CANCER VL - 115 IS - 12 CY - Hoboken, New Jersey PB - John Wiley & Sons, Inc. AB - Background: Although studies have demonstrated that women are less likely to work after they are diagnosed with breast cancer, the influence of cancer treatments on employment is less clear. The authors of this report assessed whether chemotherapy or radiation therapy was associated with a disruption in employment during the year after a breast cancer diagnosis.Methods: Using a database of health insurance claims that covered 5.6 million US residents, 3,233 women aged or=54 years were more likely to experience a change in employment than women aged 15 ng/mL). No clear relationship was found between baseline ECD levels and tumor response. After initiating combination therapy, ECD levels declined irrespective of treatment received and tumor response. For trastuzumab monotherapy, some trend between changes in ECD levels in early cycles and best response was discernable, but the overlap was too broad to be clinically useful. Disease progression was not reliably predicted by rising ECD levels in the majority of patients. CONCLUSION Based on our data, we cannot recommend using serum HER2 ECD levels to make trastuzumab or other treatment decisions for individual patients with advanced/metastatic breast cancer. SN - 0732-183X AD - Winship Cancer Institute, Emory University, School of Medicine, 1701 Uppergate Dr, Atlanta, GA 30322, USA; LEYLAND@emory.edu. U2 - PMID: 19255335. DO - 10.1200/JCO.2008.16.8351 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105490821&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105477301 T1 - Identification and management of women at high risk for hereditary breast/ovarian cancer syndrome. AU - Ozanne EM AU - Loberg A AU - Hughes S AU - Lawrence C AU - Drohan B AU - Semine A AU - Jellinek M AU - Cronin C AU - Milham F AU - Dowd D AU - Block C AU - Lockhart D AU - Sharko J AU - Grinstein G AU - Hughes KS Y1 - 2009/03//Mar/Apr2009 N1 - Accession Number: 105477301. Language: English. Entry Date: 20090522. Revision Date: 20150711. Publication Type: Journal Article; pictorial; research. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Peer Reviewed; USA. Special Interest: Informatics; Oncologic Care; Women's Health. Grant Information: MGH; and NWH. NLM UID: 9505539. KW - Decision Support Systems, Clinical KW - Hereditary Breast and Ovarian Cancer Syndrome -- Risk Factors KW - Risk Assessment KW - Descriptive Statistics KW - Female KW - Funding Source KW - Human KW - Software SP - 155 EP - 162 JO - Breast Journal JF - Breast Journal JA - BREAST J VL - 15 IS - 2 CY - Malden, Massachusetts PB - Wiley-Blackwell AB - Despite advances in identifying genetic markers of high risk patients and the availability of genetic testing, it remains challenging to efficiently identify women who are at hereditary risk and to manage their care appropriately. HughesRiskApps, an open-source family history collection, risk assessment, and Clinical Decision Support (CDS) software package, was developed to address the shortcomings in our ability to identify and treat the high risk population. This system is designed for use in primary care clinics, breast centers, and cancer risk clinics to collect family history and risk information and provide the necessary CDS to increase quality of care and efficiency. This paper reports on the first implementation of HughesRiskApps in the community hospital setting. HughesRiskApps was implemented at the Newton-Wellesley Hospital. Between April 1, 2007 and March 31, 2008, 32,966 analyses were performed on 25,763 individuals. Within this population, 915 (3.6%) individuals were found to be eligible for risk assessment and possible genetic testing based on the 10% risk of mutation threshold. During the first year of implementation, physicians and patients have fully accepted the system, and 3.6% of patients assessed have been referred to risk assessment and consideration of genetic testing. These early results indicate that the number of patients identified for risk assessment has increased dramatically and that the care of these patients is more efficient and likely more effective. SN - 1075-122X AD - *Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, MA U2 - PMID: 19292801. DO - 10.1111/j.1524-4741.2009.00690.x UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105477301&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105067014 T1 - Cost-Effectiveness of Primary versus Secondary Prophylaxis with Pegfilgrastim in Women with Early-Stage Breast Cancer Receiving Chemotherapy. AU - Ramsey SD AU - Liu Z AU - Boer R AU - Sullivan SD AU - Malin J AU - Doan QV AU - Dubois RW AU - Lyman GH Y1 - 2009/03//Mar/Apr2009 N1 - Accession Number: 105067014. Language: English. Entry Date: 20101008. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 100883818. KW - Breast Neoplasms -- Drug Therapy KW - Granulocyte Colony-Stimulating Factor -- Economics KW - Neutropenia -- Prevention and Control KW - Preventive Health Care -- Economics KW - Recurrence -- Prevention and Control KW - Adult KW - Aged KW - Aged, 80 and Over KW - Antineoplastic Agents -- Adverse Effects KW - Behavior KW - Breast Neoplasms -- Economics KW - Breast Neoplasms -- Mortality KW - Cost Benefit Analysis KW - Decision Making KW - Decision Support Techniques KW - Female KW - Fever -- Chemically Induced KW - Fever -- Economics KW - Fever -- Prevention and Control KW - Granulocyte Colony-Stimulating Factor -- Therapeutic Use KW - Health Care Costs KW - Human KW - Middle Age KW - Neutropenia -- Chemically Induced KW - Neutropenia -- Economics KW - Neutropenia -- Mortality KW - Probability KW - Quality-Adjusted Life Years KW - Relative Risk KW - Risk Assessment KW - Risk Factors KW - United States SP - 217 EP - 225 JO - Value in Health JF - Value in Health JA - VALUE HEALTH VL - 12 IS - 2 CY - New York, New York PB - Elsevier B.V. SN - 1098-3015 AD - Fred Hutchinson Cancer Research Center and University of Washington Department of Medicine, Seattle, WA, USA; U2 - PMID: 18673353. DO - 10.1111/j.1524-4733.2008.00434.x UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105067014&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105457194 T1 - Prediction of involvement of sentinel and nonsentinel lymph nodes in a Canadian population with breast cancer. AU - Ramjeesingh R AU - Quan ML AU - Gardner S AU - Holloway CM Y1 - 2009/02// N1 - Accession Number: 105457194. Language: English. Entry Date: 20090410. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Blind Peer Reviewed; Canada; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed. Special Interest: Perioperative Care. NLM UID: 0372715. KW - Breast Neoplasms -- Pathology KW - Models, Statistical KW - Neoplasm Metastasis KW - Sentinel Lymph Node Biopsy KW - Adult KW - Aged KW - Axilla KW - Breast Neoplasms -- Epidemiology KW - Breast -- Pathology KW - Canada KW - Carcinoma in Situ -- Pathology KW - Carcinoma, Ductal, Breast -- Pathology KW - Female KW - Lymph Node Excision KW - Middle Age KW - Multivariate Analysis KW - Neoplasm Invasiveness KW - Predictive Value of Tests KW - Prospective Studies KW - Human SP - 23 EP - 30 JO - Canadian Journal of Surgery JF - Canadian Journal of Surgery JA - CAN J SURG VL - 52 IS - 1 CY - Ottowa, Ontario PB - Joule Inc. AB - BACKGROUND: We sought to identify criteria for the intraoperative assessment of sentinel lymph node (SLN) involvement in women with early breast cancer. We also sought to determine whether the SLN nomogram developed by the Memorial Sloan-Kettering Cancer Center (MSKCC) to predict nonsentinel lymph node (NSLN) involvement when the SLN is positive would accurately predict NSLN involvement in our patient population. METHODS: We performed 405 SLN biopsies in 397 women between January 1998 and June 2005. We determined factors associated with SLN metastases using univariate and multivariate logistic regression. Ninety women who had 1 positive SLN or more and underwent axillary lymph node dissection (ALND) had complete data for analysis. We applied the MSKCC nomogram retrospectively to this subset of women, and we calculated the probability of NSLN involvement and compared it with the observed rate. RESULTS: Multifocality and the presence of lymphovascular invasion were predictive of SLN involvement. Ductal carcinoma in situ was negatively associated with SLN involvement. Intraoperative evaluation identified 57 (63%) of the 90 women with involved SLN, of which 26 (29%) had involved NSLN. Application of the MSKCC nomogram to our data set produced an area under the receiver operator characteristic curve of 0.71. The nomogram tended to overestimate the probability of NSLN involvement in our population. CONCLUSION: Lymphovascular invasion and multifocality were associated with SLN involvement. Women with small low-grade tumours may not require routine intraoperative evaluation of SLNs. The MSKCC nomogram appears to be most useful as a decision aid in selecting those women with an involved SLN in whom ALND may be omitted. SN - 0008-428X AD - Department of Surgery and the daggerDivision of Clinical Trials and Epidemiology, Sunnybrook Health Sciences Centre, Toronto, Ont. U2 - PMID: 19234648. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105457194&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105639859 T1 - Can women with early-stage breast cancer make an informed decision for mastectomy? AU - Collins ED AU - Moore CP AU - Clay KF AU - Kearing SA AU - O'Connor AM AU - Llewellyn-Thomas HA AU - Barth RJ Jr AU - Sepucha KR Y1 - 2009/02//2/1/2009 N1 - Accession Number: 105639859. Language: English. Entry Date: 20090306. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Oncologic Care. NLM UID: 8309333. KW - Breast Neoplasms -- Surgery KW - Consumer Participation KW - Decision Making KW - Lumpectomy KW - Mastectomy KW - Attitude to Health KW - Education KW - Female KW - Middle Age KW - Patient Education KW - Patient Satisfaction KW - Prospective Studies KW - Questionnaires KW - Human SP - 519 EP - 525 JO - Journal of Clinical Oncology JF - Journal of Clinical Oncology JA - J CLIN ONCOL VL - 27 IS - 4 CY - Alexandria, Virginia PB - American Society of Clinical Oncology AB - PURPOSE: The purpose of this study was to measure the degree to which informed women chose mastectomy, and to reveal their reasons for this choice. PATIENTS AND METHODS: This was a prospective cohort study of patients radiographically and pathologically eligible for either mastectomy or breast-conserving surgery (BCS; n = 125). Participants completed questionnaires at three time points: baseline, after viewing a decision aid, and after a surgical consultation. Questionnaires assessed clinical history, preference for participation in decision making, information comprehension, values, decisional conflict, and preferred treatment. RESULTS: Of 125 participants, 44 (35%) chose mastectomy. Most understood that BCS and mastectomy offer an equivalent survival benefit (98%) and that BCS has a slightly higher local recurrence risk (63%); most accurately identified the magnitude of ipsilateral local recurrence risk (91%). Values assigned to three treatment attributes/outcomes ('remove breast for peace of mind,' 'avoid radiation,' and 'keep breast') clearly discriminated between patients choosing mastectomy or BCS. High decisional conflict scores improved after both the decision aid and surgical consultation. CONCLUSION: Although conventional wisdom may view BCS as the preferred treatment, a notable proportion of well informed women choose mastectomy. Whereas prior studies have linked objective factors to treatment choice, this study reveals subjective preferences that underlie decision making. The systematic use of a decision aid before the surgical consultation may help women make informed, values-based decisions, while clearly reducing decisional conflict. SN - 0732-183X AD - Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA. e.dale.collins@hitchcock.org U2 - PMID: 19114703. DO - 10.1200/JCO.2008.16.6215 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105639859&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105516531 T1 - Structured data system for a breast cancer medical record. AU - Varma V AU - Varma S AU - Haq S AU - Haq MM AU - Raju N AU - Varma R A2 - McDaniel JG Y1 - 2009/02// N1 - Accession Number: 105516531. Language: English. Entry Date: 20090724. Revision Date: 20150711. Publication Type: Journal Article. Journal Subset: Computer/Information Science; Continental Europe; Editorial Board Reviewed; Europe; Peer Reviewed. Special Interest: Informatics; Oncologic Care; Women's Health. NLM UID: 9214582. KW - Breast Neoplasms KW - Electronic Health Records KW - Database Design KW - Decision Support Techniques KW - India KW - User-Computer Interface KW - World Wide Web Applications SP - 354 EP - 357 JO - Studies in Health Technology & Informatics JF - Studies in Health Technology & Informatics JA - STUD HEALTH TECHNOL INFORM VL - 143 PB - IOS Press SN - 0926-9630 AD - Emory University, Atlanta, GA, USA U2 - PMID: 19380960. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105516531&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105637591 T1 - Randomized trial of a decision aid for BRCA1/BRCA2 mutation carriers: impact on measures of decision making and satisfaction. AU - Schwartz MD AU - DeMarco TA AU - Peshkin BN AU - Lawrence W AU - Isaacs C AU - Shelby R AU - McGovern MM AU - Valdimarsdottir HB AU - Rispoli J AU - Brown K AU - O'Neill S AU - Grumet SC AU - Garnett S AU - Bremer H AU - Leaman S AU - O'Mara K AU - Kelleher S AU - Komaridis K Y1 - 2009/01// N1 - Accession Number: 105637591. Language: English. Entry Date: 20090403. Revision Date: 20150711. Publication Type: Journal Article; clinical trial; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Oncologic Care; Psychiatry/Psychology; Women's Health. Instrumentation: Decisional Conflict Scale (DCS) (O'Connor); Satisfaction With Decision Scale (SWD) (Holmes-Rovner et al). Grant Information: Supported by National Cancer Institute Grant RO1 CA01846. NLM UID: 8211523. KW - Heterozygote -- Psychosocial Factors KW - Decision Support Techniques -- Evaluation KW - Genes, BRCA KW - Mastectomy -- Psychosocial Factors KW - Adult KW - Aged KW - Bivariate Statistics KW - Breast Neoplasms -- Familial and Genetic KW - CD ROM KW - Chi Square Test KW - Clinical Assessment Tools KW - Clinical Trials KW - Confidence Intervals KW - Conflict (Psychology) KW - Decision Making, Computer Assisted KW - Decision Making, Patient KW - District of Columbia KW - Female KW - Fisher's Exact Test KW - Funding Source KW - Genetic Counseling KW - Genetic Screening KW - Interviews KW - Linear Regression KW - Logistic Regression KW - Middle Age KW - New Jersey KW - New York KW - Odds Ratio KW - Patient Satisfaction KW - Post Hoc Analysis KW - Prospective Studies KW - Summated Rating Scaling KW - Time Factors KW - Human SP - 11 EP - 19 JO - Health Psychology JF - Health Psychology JA - HEALTH PSYCHOL VL - 28 IS - 1 CY - Washington, District of Columbia PB - American Psychological Association AB - Objective: Genetic testing is increasingly part of routine clinical care for women with a family history of breast cancer. Given their substantially elevated risk for breast cancer, BRCA1/BRCA2 mutation carriers must make the difficult decision whether or not to opt for risk reducing mastectomy. To help BRCA1/2 carriers make this decision, the authors developed a computer-based interactive decision aid that was tested against usual care in a randomized controlled trial. Design: After the completion of genetic counseling, 214 female (aged 21-75) BRCA1/BRCA2 mutation carriers were randomized to Usual Care (UC; N = 114) or Usual Care plus Decision Aid (DA; N = 100) arms. UC participants received no additional intervention. DA participants were sent the CD-ROM DA to view at home. Main Outcome Measures: The authors measured final management decision, decisional conflict, decisional satisfaction, and receipt of risk reducing mastectomy at 1-, 6-, and 12-months postrandomization. Results: Longitudinal analyses revealed that the DA was effective among carriers who were initially undecided about how to manage their breast cancer risk. Within this group, the DA led to an increased likelihood of reaching a management decision (OR = 3.09, 95% CI = 1.62, 5.90; p < .001), decreased decisional conflict (B = -.46, z = -3.1, p <002), and increased satisfaction (B = .27, z = 3.1, p = .002) compared to UC. Among carriers who had already made a management decision by the time of randomization, the DA had no benefit relative to UC. Conclusion: These results demonstrate that BRCA1/BRCA2 mutation carriers who are having difficulty making a breast cancer risk management decision can benefit from adjunct decision support. Copyright © 2009 by the American Psychological Association, Inc. SN - 0278-6133 AD - Cancer Control Program and Fisher Center for Familial Cancer Research, Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW Stuite 4100, Washington, DC 20007; schwartm@georgetown.edu U2 - PMID: 19210013. DO - 10.1037/a0013147 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105637591&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105517176 T1 - Concise evaluation of decision aids. AU - Stalmeier PFM AU - Roosmalen MS Y1 - 2009/01// N1 - Accession Number: 105517176. Language: English. Entry Date: 20090508. Revision Date: 20150711. Publication Type: Journal Article; clinical trial; research; tables/charts. Journal Subset: Core Nursing; Europe; Health Promotion/Education; Nursing; Peer Reviewed; UK & Ireland. Instrumentation: Center for Epidemiologic Studies Depression Scale (CES-D); State-Trait Anxiety Inventory (STAI) (Spielberger); Decision Evaluation Scale; Impact of Events Scale (IES). Grant Information: Dutch Cancer Society, Amsterdam, the Netherlands (projects NUKC 98-1585 and KUN 2005-3457). NLM UID: 8406280. KW - Breast Neoplasms -- Prevention and Control KW - Decision Making KW - Decision Support Techniques KW - Patient Compliance KW - Patient Education -- Methods KW - Breast Neoplasms -- Familial and Genetic KW - Center for Epidemiological Studies Depression Scale KW - Clinical Trials KW - Comparative Studies KW - Effect Size KW - Factor Analysis KW - Female KW - Funding Source KW - Impact of Events Scale KW - Interviews KW - Life Expectancy KW - Netherlands KW - Pamphlets KW - Patient Education -- Standards KW - Patient Satisfaction -- Statistics and Numerical Data KW - Prognosis KW - Quality of Life KW - Random Assignment KW - Risk Assessment KW - Risk Factors KW - Sample Size KW - Scales KW - State-Trait Anxiety Inventory KW - Videorecording KW - Human SP - 104 EP - 109 JO - Patient Education & Counseling JF - Patient Education & Counseling JA - PATIENT EDUC COUNS VL - 74 IS - 1 PB - Elsevier B.V. AB - Objective Decision aids purport to help patients make treatment related choices. Several instruments exist to evaluate decision aids. Our aim is to compare the responsiveness of several instruments. Methods Two different decision aids were randomized in patients at high risk for breast and ovarian cancer. Treatment choices were between prophylactic surgery and screening. Effect sizes were calculated to compare the responsiveness of the measures. Results One decision aid was randomized in 390 women, the other in 91 ensuing mutation carriers. Three factors were identified related to Information, Well-being and Decision Making. Within each factor, single item measures were as responsive as multi-item measures. Conclusion Four single items, 'the amount of information received for decision making,''strength of preference,'' I weighed the pros and cons,' and 'General Health,' were adequately responsive to the decision aids. Practice implications These items might be considered for inclusion in questionnaires to evaluate decision aids. SN - 0738-3991 AD - Department of Radiation Oncology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands U2 - PMID: 18775622. DO - 10.1016/j.pec.2008.07.043 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105517176&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105474295 T1 - Visualizing treatment options for breast reconstructive surgery. AU - Qualter J AU - Fana M AU - Deluccia N AU - Colen K AU - Scharf C AU - Hazen A A2 - Westwood JD A2 - Westwood SW A2 - Haluck RS A2 - Hoffman HM A2 - Mogel GT A2 - Phillips R A2 - Robb RA A2 - Vosburgh KG Y1 - 2009/01// N1 - Accession Number: 105474295. Language: English. Entry Date: 20090508. Revision Date: 20150711. Publication Type: Journal Article; pictorial. Journal Subset: Computer/Information Science; Continental Europe; Editorial Board Reviewed; Europe; Peer Reviewed. Special Interest: Informatics. NLM UID: 9214582. KW - Breast Reconstruction -- Methods KW - Computer Simulation KW - Decision Support Techniques KW - Decision Making, Patient KW - New York KW - Patient Education SP - 262 EP - 264 JO - Studies in Health Technology & Informatics JF - Studies in Health Technology & Informatics JA - STUD HEALTH TECHNOL INFORM VL - 142 PB - IOS Press SN - 0926-9630 AD - New York University School of Medicine, Division of Educational Informatics, New York, NY 10016 U2 - PMID: 19377163. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105474295&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105469384 T1 - Effectiveness of decision aids: a review of the evidence. AU - Leatherman S AU - Warrick L Y1 - 2008/12/02/Dec2008 Supplement N1 - Accession Number: 105469384. Language: English. Entry Date: 20090403. Revision Date: 20150711. Publication Type: Journal Article; review; tables/charts. Supplement Title: Dec2008 Supplement. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 9506850. KW - Decision Making, Patient KW - Decision Support Techniques KW - Aneuploidy -- Prevention and Control KW - Breast Neoplasms -- Prevention and Control KW - Cancer Screening -- Methods KW - Cervix Neoplasms -- Prevention and Control KW - Colorectal Neoplasms -- Prevention and Control KW - Genetic Screening KW - Health Care Costs KW - Health Resource Utilization KW - Mammography KW - Outcomes (Health Care) KW - Patient Satisfaction KW - Prenatal Diagnosis KW - Prostate-Specific Antigen -- Blood KW - Prostatic Neoplasms -- Prevention and Control KW - Quality of Health Care KW - Quality of Life SP - 79S EP - 116S JO - Medical Care Research & Review JF - Medical Care Research & Review JA - MED CARE RES REV VL - 65 IS - 6S CY - Thousand Oaks, California PB - Sage Publications Inc. AB - Increased interest in health care consumerism has created an environment conducive to growth in the use of decision aids (DAs) to support patient decision making. The authors review the research literature published within the past 5 years that assesses the effects of DAs in the areas of screening and treatment. Multiple measures are used to evaluate the effectiveness of DAs, with mixed evidence of impacts. To date, most evidence from screening studies suggests that DAs are effective in increasing knowledge and are acceptable to patients, but patient uptake of screening has been mixed. Among treatment studies, there is some, but limited, evidence showing impact of DAs on immediate and long-term decisional conflict, patient satisfaction, and quality of life. Few studies provide assessment of impact on health outcomes, quality of care, utilization, or costs, all areas likely to be of growing interest to private purchasers, insurers, and public programs. SN - 1077-5587 AD - University of North Carolina U2 - PMID: 19015379. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105469384&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105603197 T1 - Evaluation of international treatment guidelines and prognostic tests for the treatment of early breast cancer. AU - Muñoz M AU - Estévez LG AU - Alvarez I AU - Fernández Y AU - Margelí M AU - Tusquets I AU - Seguí MA AU - Lluch A Y1 - 2008/12// N1 - Accession Number: 105603197. Language: English. Entry Date: 20090213. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Double Blind Peer Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care. NLM UID: 7502030. KW - Breast Neoplasms -- Pathology KW - Breast Neoplasms -- Therapy KW - Lumpectomy -- Methods KW - Neoplasm Invasiveness -- Pathology KW - Practice Guidelines KW - Adult KW - Aged KW - Antineoplastic Agents -- Administration and Dosage KW - Biopsy, Needle KW - Breast Neoplasms -- Mortality KW - Breast Neoplasms KW - Chemotherapy, Adjuvant KW - Combined Modality Therapy KW - Drug Therapy, Computer Assisted KW - Female KW - Immunohistochemistry KW - International Relations KW - Middle Age KW - Neoadjuvant Therapy KW - Neoplasm Staging KW - Prognosis KW - Risk Assessment KW - Survival Analysis KW - Treatment Outcomes KW - Tumor Markers, Biological -- Analysis KW - Tumor Markers, Biological KW - Human SP - 701 EP - 709 JO - Cancer Treatment Reviews JF - Cancer Treatment Reviews JA - CANCER TREAT REV VL - 34 IS - 8 CY - Philadelphia, Pennsylvania PB - W B Saunders AB - The clinical decision to treat early-stage breast cancer with adjuvant chemotherapy is sometimes a difficult one because 70-80% of patients who receive chemotherapy would probably have survived without it. To help clinicians in this decision-making process, different tools or 'decision aids' have been developed for the treatment of early breast cancer over the years. Some of these tools include clinical treatment guidelines and computer-based programs as well as different prognostic and/or predictive tests such as those based on gene expression profiles or the presence minimum invasive disease. All of these tools try to individualize as much as possible the estimation of the risk of breast cancer relapse and death and to facilitate the clinical decision about giving additional treatment, and ultimately the most appropriate treatment to be given. Thus, it is important for clinicians to be aware of not only the existence of these tools or 'decision aids', but also to know how they have been developed, how frequently there are revised and if they have been validated. In order to address all these concerns, we have carried out a critical review of the most important prognostic tests and clinical guidelines for the treatment of early breast cancer. Information regarding their development process as well as frequency of revision, validations that have been performed and main limitations of each tool were gathered and critically analyzed. SN - 0305-7372 AD - Hospital Clinic i Provincial, Servicio de Oncología Médica, IDIBAPS, C/Villarroel, 170, 08036 Barcelona, Spain. mmunoz@clinic.ub.es U2 - PMID: 18922644. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105603197&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105570878 T1 - Keeping the noise down: common random numbers for disease simulation modeling. AU - Stout NK AU - Goldie SJ AU - Stout, Natasha K AU - Goldie, Sue J Y1 - 2008/12// N1 - Accession Number: 105570878. Language: English. Entry Date: 20090130. Revision Date: 20161202. Publication Type: journal article; research. Journal Subset: Biomedical; Continental Europe; Double Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Health Services Administration; Peer Reviewed. Grant Information: T32 HS000083-12//None/None. NLM UID: 9815649. KW - Breast Neoplasms KW - Models, Statistical KW - Female KW - Mammography SP - 399 EP - 406 JO - Health Care Management Science JF - Health Care Management Science JA - HEALTH CARE MANAGE SCI VL - 11 IS - 4 CY - , PB - Springer Science & Business Media B.V. AB - Disease simulation models are used to conduct decision analyses of the comparative benefits and risks associated with preventive and treatment strategies. To address increasing model complexity and computational intensity, modelers use variance reduction techniques to reduce stochastic noise and improve computational efficiency. One technique, common random numbers, further allows modelers to conduct counterfactual-like analyses with direct computation of statistics at the individual level. This technique uses synchronized random numbers across model runs to induce correlation in model output thereby making differences easier to distinguish as well as simulating identical individuals across model runs. We provide a tutorial introduction and demonstrate the application of common random numbers in an individual-level simulation model of the epidemiology of breast cancer. SN - 1386-9620 AD - Program in Health Decision Science, Harvard School of Public Health, 718 Huntington Ave., Boston, MA 02115, USA AD - Program in Health Decision Science, Harvard School of Public Health, 718 Huntington Ave., Boston, MA 02115, USA. nstout@hsph.harvard.edu U2 - PMID: 18998599. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105570878&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105587754 T1 - Treatment decision making among Chinese women with DCIS. AU - Wong ST AU - Chen W AU - Bottorff JL AU - Hislop TG Y1 - 2008/12// N1 - Accession Number: 105587754. Language: English. Entry Date: 20090220. Revision Date: 20150819. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Oncologic Care; Psychiatry/Psychology. Grant Information: National Institute of Aging. NLM UID: 8309337. KW - Breast Neoplasms -- Surgery KW - Chinese -- Canada KW - Decision Making, Patient KW - Neoplasms, Ductal, Lobular, and Medullary KW - Canada KW - Descriptive Statistics KW - Female KW - Funding Source KW - Information Needs KW - Interviews KW - Mastectomy KW - Middle Age KW - Retrospective Design KW - Thematic Analysis KW - Women's Health KW - Human SP - 53 EP - 73 JO - Journal of Psychosocial Oncology JF - Journal of Psychosocial Oncology JA - J PSYCHOSOC ONCOL VL - 26 IS - 4 PB - Taylor & Francis Ltd AB - One result of the widespread screening mammography is a 200% increase in the rates of breast ductal carcinoma in situ (DCIS). Treatment decision making among Chinese women diagnosed with DCIS remains understudied. This study examined Chinese-Canadian women's experiences (N = 26): (1) with treatment decision making (mastectomy or breast conserving surgery) and (2) their reflections on the decision-making process. Interviews in Cantonese, Mandarin, or English were transcribed and translated, and a content analysis conducted. Women's treatment decisions reflected a lack of understanding of DCIS, the desire to rid themselves of breast cancer forever, and the influence of significant others. English as a second language and use of medical jargon impeded their ability to make informed treatment decisions. Women's reflections on the decision-making process provided insights into how to improve information and support treatment decision making in ways that are accessible to them. SN - 0734-7332 AD - University of British Columbia, School of Nursing, Vancouver, British Columbia, Canada. sabrina.wong@nursing.ubc.ca U2 - PMID: 19042272. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105587754&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105600865 T1 - Can people find patient decision aids on the Internet? AU - Morris D AU - Drake E AU - Saarimaki A AU - Bennett C AU - O'Connor A Y1 - 2008/12// N1 - Accession Number: 105600865. Language: English. Entry Date: 20090306. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Core Nursing; Europe; Health Promotion/Education; Nursing; Peer Reviewed; UK & Ireland. NLM UID: 8406280. KW - Decision Support Techniques KW - Information Retrieval -- Methods KW - Internet -- Administration KW - Patient Education -- Administration KW - Arthritis -- Therapy KW - Breast Neoplasms -- Surgery KW - Consumer Participation -- Methods KW - Consumer Participation -- Psychosocial Factors KW - Female KW - Information Retrieval -- Standards KW - Information Services -- Administration KW - Leiomyoma -- Therapy KW - Low Back Pain -- Therapy KW - Male KW - Needs Assessment KW - Prostatic Neoplasms -- Diagnosis KW - Vocabulary, Controlled KW - Human SP - 557 EP - 560 JO - Patient Education & Counseling JF - Patient Education & Counseling JA - PATIENT EDUC COUNS VL - 73 IS - 3 PB - Elsevier B.V. AB - OBJECTIVE: To determine if people could find patient decision aids (PtDAs) on the Internet using the most popular general search engines. METHODS: We chose five medical conditions for which English language PtDAs were available from at least three different developers. The search engines used were: Google (www.google.com), Yahoo! (www.yahoo.com), and MSN (www.msn.com). For each condition and search engine we ran six searches using a combination of search terms. We coded all non-sponsored Web pages that were linked from the first page of the search results. RESULTS: Most first page results linked to informational Web pages about the condition, only 16% linked to PtDAs. PtDAs were more readily found for the breast cancer surgery decision (our searches found seven of the nine developers). The searches using Yahoo and Google search engines were more likely to find PtDAs. The following combination of search terms: condition, treatment, decision (e.g. breast cancer surgery decision) was most successful across all search engines (29%). CONCLUSION: While some terms and search engines were more successful, few resulted in direct links to PtDAs. PRACTICE IMPLICATIONS: Finding PtDAs would be improved with use of standardized labelling, providing patients with specific Web site addresses or access to an independent PtDA clearinghouse. SN - 0738-3991 AD - Ottawa Health Research Institute, Ottawa, Canada. U2 - PMID: 18789628. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105600865&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105587464 T1 - Cancer treatment-induced bone loss in breast and prostate cancer. AU - Saad F AU - Adachi JD AU - Brown JP AU - Canning LA AU - Gelmon KA AU - Josse RG AU - Pritchard KI Y1 - 2008/11/20/ N1 - Accession Number: 105587464. Language: English. Entry Date: 20090227. Revision Date: 20150711. Publication Type: Journal Article; research; systematic review; tables/charts. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Evidence-Based Practice; Oncologic Care. Grant Information: Supported in part by Sanofi-Aventis. NLM UID: 8309333. KW - Androgen Antagonists -- Adverse Effects KW - Antineoplastic Agents, Hormonal -- Adverse Effects KW - Aromatase Inhibitors -- Adverse Effects KW - Bone Diseases, Metabolic -- Chemically Induced KW - Breast Neoplasms -- Drug Therapy KW - Prostatic Neoplasms -- Drug Therapy KW - Androgen Antagonists -- Therapeutic Use KW - Antineoplastic Agents, Hormonal -- Therapeutic Use KW - Aromatase Inhibitors -- Therapeutic Use KW - Bone Density -- Drug Effects KW - Bone Diseases, Metabolic -- Prevention and Control KW - Diphosphonates -- Therapeutic Use KW - Female KW - Fractures, Spontaneous -- Chemically Induced KW - Fractures, Spontaneous -- Prevention and Control KW - Funding Source KW - Medical Practice, Evidence-Based KW - Systematic Review KW - Human SP - 5465 EP - 5476 JO - Journal of Clinical Oncology JF - Journal of Clinical Oncology JA - J CLIN ONCOL VL - 26 IS - 33 CY - Alexandria, Virginia PB - American Society of Clinical Oncology AB - PURPOSE: Bone loss resulting from the treatment of breast and prostate cancer is an emerging problem. Bisphosphonates have a potential role in the prevention of this cancer treatment-induced bone loss (CTIBL). METHODS: Studies evaluating the incidence and prevalence of CTIBL in early breast and prostate cancer patients and trials evaluating the preventative role of bisphosphonates were identified by a search of the PubMed and Cochrane Library databases through the end of March 2008. Reference lists from retrieved articles were cross referenced, and further information was obtained from relevant scientific meetings. RESULTS: Several therapies commonly used in the treatment of women and men with breast and prostate cancers, in particular the aromatase inhibitors (AIs) for breast cancer and androgen deprivation therapy (ADT) for prostate cancer, are associated with significant bone loss and with an increase in fracture risk. The use of bisphosphonates seems to attenuate the bone loss, although the long-term impact remains unclear because of insufficient follow-up. CONCLUSION: Adjuvant endocrine therapy with an AI or androgen deprivation can be considered a risk factor for the development of osteopenia, osteoporosis, and bone fracture, which can be mitigated by appropriate bisphosphonate therapy. Clear identification of risk factors for osteoporosis in individual patients should aid treatment decisions about whether to use bisphosphonates when starting or switching to an AI or ADT. Patients need to be educated about this risk and other measures to avoid this complication, including lifestyle modifications that may benefit their general and bone health. SN - 0732-183X AD - Department of Surgery/Urology, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Quebec, Canada. U2 - PMID: 18955443. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105587464&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105594087 T1 - Communicating side effect risks in a tamoxifen prophylaxis decision aid: the debiasing influence of pictographs. AU - Zikmund-Fisher BJ AU - Ubel PA AU - Smith DM AU - Derry HA AU - McClure JB AU - Stark A AU - Pitsch RK AU - Fagerlin A AU - Zikmund-Fisher, Brian J AU - Ubel, Peter A AU - Smith, Dylan M AU - Derry, Holly A AU - McClure, Jennifer B AU - Stark, Azadeh AU - Pitsch, Rosemarie K AU - Fagerlin, Angela Y1 - 2008/11// N1 - Accession Number: 105594087. Language: English. Entry Date: 20090327. Revision Date: 20161125. Publication Type: journal article; research; tables/charts. Journal Subset: Core Nursing; Europe; Health Promotion/Education; Nursing; Peer Reviewed; UK & Ireland. Grant Information: P50 CA101451-03/CA/NCI NIH HHS/United States. NLM UID: 8406280. KW - Breast Neoplasms -- Prevention and Control KW - Chemoprevention KW - Communication KW - Patient Education KW - Tamoxifen -- Administration and Dosage KW - Tamoxifen -- Adverse Effects KW - Adult KW - Aged KW - Breast Neoplasms -- Risk Factors KW - Data Analysis Software KW - Decision Making, Patient KW - Female KW - Funding Source KW - Michigan KW - Middle Age KW - Multivariate Analysis of Variance KW - Photography KW - Questionnaires KW - Washington KW - Human SP - 209 EP - 214 JO - Patient Education & Counseling JF - Patient Education & Counseling JA - PATIENT EDUC COUNS VL - 73 IS - 2 PB - Elsevier B.V. AB - Objective: To experimentally test whether using pictographs (image matrices), incremental risk formats, and varied risk denominators would influence perceptions and comprehension of side effect risks in an online decision aid about prophylactic use of tamoxifen to prevent primary breast cancers.Methods: We recruited 631 women with elevated breast cancer risk from two healthcare organizations. Participants saw tailored estimates of the risks of 5 side effects: endometrial cancer, blood clotting, cataracts, hormonal symptoms, and sexual problems. Presentation format was randomly varied in a three factor design: (A) risk information was displayed either in pictographs or numeric text; (B) presentations either reported total risks with and without tamoxifen or highlighted the incremental risk most relevant for decision making; and (C) risk estimates used 100 or 1000 person denominators. Primary outcome measures included risk perceptions and gist knowledge.Results: Incremental risk formats consistently lowered perceived risk of side effects but resulted in low knowledge when displayed by numeric text only. Adding pictographs, however, produced significantly higher comprehension levels.Conclusions: Pictographs make risk statistics easier to interpret, reducing biases associated with incremental risk presentations.Practice Implications: Including graphs in risk communications is essential to support an informed treatment decision-making process. SN - 0738-3991 AD - VA Health Services Research & Development Center of Excellence, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA AD - VA Health Services Research & Development Center of Excellence, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States; bzikmund@umich.edu U2 - PMID: 18602242. DO - 10.1016/j.pec.2008.05.010 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105594087&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105702212 T1 - Unsuccessful preoperative biopsies, fine needle aspiration cytology or core needle biopsy, lead to increased costs in the diagnostic workup in breast cancer. AU - Hukkinen K AU - Kivisaari L AU - Heikkila PS AU - Von Smitten K AU - Leidenius M Y1 - 2008/09// N1 - Accession Number: 105702212. Language: English. Entry Date: 20081128. Revision Date: 20150711. Publication Type: Journal Article. Journal Subset: Biomedical; Continental Europe; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed. Special Interest: Oncologic Care. NLM UID: 8709065. KW - Biopsy, Needle -- Economics KW - Biopsy, Needle -- Methods KW - Breast Neoplasms -- Diagnosis KW - Breast Neoplasms -- Economics KW - Adenocarcinoma -- Diagnosis KW - Adenocarcinoma -- Economics KW - Adult KW - Aged KW - Breast Neoplasms -- Pathology KW - Breast Neoplasms -- Surgery KW - Breast Neoplasms -- Ultrasonography KW - Carcinoma, Ductal, Breast -- Diagnosis KW - Carcinoma, Ductal, Breast -- Economics KW - Decision Trees KW - Diagnosis, Differential KW - Female KW - Finland KW - Health Care Costs KW - Middle Age KW - Neoplasms, Ductal, Lobular, and Medullary -- Diagnosis KW - Neoplasms, Ductal, Lobular, and Medullary -- Economics KW - Time Factors KW - Ultrasonography -- Economics KW - Unnecessary Procedures -- Economics SP - 1037 EP - 1045 JO - Acta Oncologica JF - Acta Oncologica JA - ACTA ONCOL VL - 47 IS - 6 CY - Philadelphia, Pennsylvania PB - Taylor & Francis Ltd AB - Correct preoperative diagnosis of a breast lesion is essential for optimal treatment planning. Our aim was to compare feasibility of fine needle aspiration cytology (FNAC) and core needle biopsy (CNB) in diagnosis of breast lesions. The special aim was to evaluate the extra costs and delay in surgical treatment due to unsuccessful preoperative biopsies. Diagnostic work-ups in 572 patients with 580 breast lesions were retrospectively evaluated. FNAC was the first biopsy method for 339 lesions, CNB for 241 lesions. The postoperative diagnosis was malignant for 503 lesions. The preoperative rate of definitely malignant diagnosis was 67% (194/289) for FNAC and 96% (206/214) for CNB (p < 0.0001), and 95% and 99%, respectively (p = 0.0173), when also suspicious findings were included. In patients with FNAC, an additional needle biopsy was performed for 93 and a surgical biopsy for 62 lesions. In the CNB group, a subsequent CNB was performed for 2 and a surgical biopsy for 33. The frequent need for additional biopsies raised the total expenses of FNAC over those of CNB. Multiple biopsies may also delay cancer surgery. It is therefore recommended to use CNB as the initial needle biopsy method. SN - 0284-186X U2 - PMID: 18607862. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105702212&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105660511 T1 - Supporting participation in clinical research: decision aids for trial recruitment? AU - Entwistle V Y1 - 2008/09// N1 - Accession Number: 105660511. Language: English. Entry Date: 20081010. Revision Date: 20150711. Publication Type: Journal Article; commentary; editorial. Original Study: Juraskova I, Butow P, Lopez A, Seccombe M, Coates A, Boyle F, et al. Improving informed consent: pilot of a decision aid for women invited to participate in a breast cancer prevention trial (IBIS-II DCIS) (HEALTH EXPECTATIONS) Sep2008; 11 (3): 252-262. Journal Subset: Europe; Health Services Administration; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care; Women's Health. NLM UID: 9815926. KW - Breast Neoplasms -- Prevention and Control KW - Decision Support Techniques -- Evaluation KW - Female KW - Research Subject Recruitment SP - 205 EP - 207 JO - Health Expectations JF - Health Expectations JA - HEALTH EXPECTATIONS VL - 11 IS - 3 CY - Malden, Massachusetts PB - Wiley-Blackwell SN - 1369-6513 U2 - PMID: 18816317. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105660511&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105660517 T1 - Improving informed consent: pilot of a decision aid for women invited to participate in a breast cancer prevention trial (IBIS-II DCIS) AU - Juraskova I AU - Butow P AU - Lopez A AU - Seccombe M AU - Coates A AU - Boyle F AU - McCarthy N AU - Reaby L AU - Forbes JF Y1 - 2008/09// N1 - Accession Number: 105660517. Language: English. Entry Date: 20081010. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Commentary: Entwistle V. Supporting participation in clinical research: decision aids for trial recruitment? (HEALTH EXPECTATIONS) Sep2008; 11 (3): 205-207. Journal Subset: Europe; Health Services Administration; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care; Women's Health. Grant Information: Supported by the ANZ BCTG and a Susan G KOMEN Breast Cancer Foundation grant. NLM UID: 9815926. KW - Breast Neoplasms -- Therapy KW - Consent KW - Decision Making, Patient KW - Decision Support Techniques -- Evaluation KW - Adult KW - Aged KW - Content Analysis KW - Descriptive Statistics KW - Female KW - Funding Source KW - Interviews KW - Knowledge -- Evaluation KW - Middle Age KW - New South Wales KW - Pilot Studies KW - Human SP - 252 EP - 262 JO - Health Expectations JF - Health Expectations JA - HEALTH EXPECTATIONS VL - 11 IS - 3 CY - Malden, Massachusetts PB - Wiley-Blackwell AB - Background Patients and clinicians report difficulties with the process of informed consent to clinical trials and audiotape audits show that critical information is often omitted or poorly presented. Decision aids (DAs) may assist in improving consent. Aims This study piloted a DA booklet for a high priority breast cancer prevention trial, IBIS-II DCIS, which compares the efficacy of an aromatase inhibitor (anastrozole) with tamoxifen in women who have had surgery for ductal carcinoma in situ (DCIS). Method Thirty-one Australian women participating in the IBIS-I breast cancer prevention trial and who are currently in follow-up agreed to read the IBIS-II DCIS participant information sheet and the DCIS DA booklet, complete a set of standardized questionnaires, and provide feedback on the DA via a semi-structured phone interview. Results Women found the DA helpful in deciding about trial participation, reporting that it aided their understanding over and above the approved IBIS-II DCIS participant information sheet and was not anxiety provoking. Women's understanding of the rationale and methods of clinical trials and the IBIS-II DCIS trial was very good; with more than 80% of items answered correctly. The only areas that were not understood well were the concepts of randomization and blinding. Conclusions This study suggests that the DA will be acceptable to and valued by potential participants in the IBIS-II DCIS study. The revised DA is currently being evaluated prospectively in a randomized controlled trial. If successful, such DAs could transform the consent process to large clinical trials and may also reduce dropout rates. SN - 1369-6513 AD - Medical Psychology Research Unit, School of Psychology, Brennan MacCallum bld (A18), University of Sydney, Sydney, NSW 2006 Australia U2 - PMID: 18816321. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105660517&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105660837 T1 - Experiencing cancer treatment decision-making in managed care. AU - Wenzel J AU - Shaha M Y1 - 2008/09// N1 - Accession Number: 105660837. Language: English. Entry Date: 20081010. Revision Date: 20150819. Publication Type: Journal Article; research; tables/charts. Journal Subset: Core Nursing; Europe; Nursing; Peer Reviewed; UK & Ireland. Special Interest: Advanced Nursing Practice; Oncologic Care. Grant Information: Funded by a University of Virginia School of Nursing Dissertation Fellowship: the Barbara Brodie Scholars Endowment Award, with support by the Johns Hopkins University School of Nursing Center for Collaborative Intervention Research (NINR P30 NRO 8995). NLM UID: 7609811. KW - Breast Neoplasms KW - Cancer Patients KW - Decision Making, Clinical KW - Decision Making, Patient KW - Managed Care Programs KW - Oncologic Care KW - Adult KW - Aged KW - Conflict (Psychology) KW - Female KW - Field Notes KW - Funding Source KW - Interviews KW - Middle Age KW - Patient Attitudes -- Evaluation KW - Phenomenological Research KW - Purposive Sample KW - Reflection KW - Thematic Analysis KW - United States KW - Human SP - 455 EP - 464 JO - Journal of Advanced Nursing JF - Journal of Advanced Nursing JA - J ADV NURS VL - 63 IS - 5 CY - Malden, Massachusetts PB - Wiley-Blackwell AB - Aim. This paper is a report of a study to explore women's perceptions of and experiences with breast cancer treatment decision-making in managed care organizations (MCOs). Background. Managed care organizations are the predominant form of employer-sponsored healthcare insurance in the United States of America. These healthcare financing entities minimize cost by streamlining healthcare delivery and may impose choice restrictions. The extent of these restrictions has not previously been studied from an in-depth patient perspective. Method. A qualitative descriptive approach was adopted using interviews with a purposive sample of 14 managed care enrollees diagnosed with breast cancer at all stages. The data were collected between 2003 and 2005. Data analysis involved a reflexive process of transcript reading, categorization, data reduction and interpretation. Findings. The findings are presented as a single theme: 'decisional conflict in managed care', with two distinct categories: decisions regarding (1) the MCOs and (2) treatment. MCO selection was perceived to be limited by employer constraints, cost issues or healthcare plan providers. For study participants, selecting a MCO was less difficult than issues surrounding treatment decision-making. Women reported that their most important treatment-related decisions surrounded diagnosis and involved selecting a treatment facility and provider. Once a satisfactory facility and provider were selected, these women preferred to defer treatment decisions to their healthcare providers. Conclusion. Decision interventions should be focused on assisting women with provider and treatment facility selection early in diagnosis. Our findings might also serve as a basis for policy/practice changes to address healthcare financing limitations and to expand cancer treatment-related choices while providing desired treatment decision-making support. SN - 0309-2402 AD - Assistant Professor, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA U2 - PMID: 18727748. DO - 10.1111/j.1365-2648.2008.04720.x UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105660837&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105690494 T1 - Prognostic utility of the 21-gene assay in hormone receptor-positive operable breast cancer compared with classical clinicopathologic features. AU - Goldstein LJ AU - Gray R AU - Badve S AU - Childs BH AU - Yoshizawa C AU - Rowley S AU - Shak S AU - Baehner FL AU - Ravdin PM AU - Davidson NE AU - Sledge GW Jr. AU - Perez EA AU - Shulman LN AU - Martino S AU - Sparano JA AU - Goldstein, Lori J AU - Gray, Robert AU - Badve, Sunil AU - Childs, Barrett H AU - Yoshizawa, Carl Y1 - 2008/09//9/1/2008 N1 - Accession Number: 105690494. Language: English. Entry Date: 20081114. Revision Date: 20161222. Publication Type: journal article; glossary; research; tables/charts. Commentary: Paik S, Tang G, Fumagalli D. An ideal prognostic test for estrogen receptor--positive breast cancer? (J CLIN ONCOL) 9/1/2008; 26 (25): 4058-4059. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Oncologic Care. Grant Information: CA32012/CA/NCI NIH HHS/United States. NLM UID: 8309333. KW - Breast Neoplasms -- Diagnosis KW - Breast Neoplasms -- Familial and Genetic KW - Gene Expression KW - Genetic Techniques KW - Receptors, Cell Surface KW - Adult KW - Aged KW - Algorithms KW - Breast Neoplasms -- Pathology KW - Confidence Intervals KW - Cox Proportional Hazards Model KW - Female KW - Funding Source KW - Immunohistochemistry KW - Middle Age KW - Patient Selection KW - Prognosis KW - Recurrence KW - Risk Assessment -- Methods KW - ROC Curve KW - Human SP - 4063 EP - 4071 JO - Journal of Clinical Oncology JF - Journal of Clinical Oncology JA - J CLIN ONCOL VL - 26 IS - 25 CY - Alexandria, Virginia PB - American Society of Clinical Oncology AB - Purpose: Adjuvant! is a standardized validated decision aid that projects outcomes in operable breast cancer based on classical clinicopathologic features and therapy. Genomic classifiers offer the potential to more accurately identify individuals who benefit from chemotherapy than clinicopathologic features.Patients and Methods: A sample of 465 patients with hormone receptor (HR) -positive breast cancer with zero to three positive axillary nodes who did (n = 99) or did not have recurrence after chemohormonal therapy had tumor tissue evaluated using a 21-gene assay. Histologic grade and HR expression were evaluated locally and in a central laboratory.Results: Recurrence Score (RS) was a highly significant predictor of recurrence, including node-negative and node-positive disease (P < .001 for both) and when adjusted for other clinical variables. RS also predicted recurrence more accurately than clinical variables when integrated by an algorithm modeled after Adjuvant! that was adjusted to 5-year outcomes. The 5-year recurrence rate was only 5% or less for the estimated 46% of patients who have a low RS (< 18).Conclusion: The 21-gene assay was a more accurate predictor of relapse than standard clinical features for individual patients with HR-positive operable breast cancer treated with chemohormonal therapy and provides information that is complementary to features typically used in anatomic staging, such as tumor size and lymph node involvement. The 21-gene assay may be used to select low-risk patients for abbreviated chemotherapy regimens similar to those used in our study or high-risk patients for more aggressive regimens or clinical trials evaluating novel treatments. SN - 0732-183X AD - Eastern Cooperative Oncology Group, Boston, MA, USA U2 - PMID: 18678838. DO - 10.1200/JCO.2007.14.4501 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105690494&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105689355 T1 - Clinical guidelines and care pathways: a case study applying PROforma decision support technology to the breast cancer care pathway. AU - Patkar V AU - Fox J Y1 - 2008/09// N1 - Accession Number: 105689355. Language: English. Entry Date: 20081114. Revision Date: 20150711. Publication Type: Journal Article; case study; pictorial; research; tables/charts. Journal Subset: Computer/Information Science; Continental Europe; Editorial Board Reviewed; Europe; Peer Reviewed. Special Interest: Informatics. NLM UID: 9214582. KW - Breast Neoplasms -- Prevention and Control KW - Decision Support Systems, Clinical -- Utilization KW - Chi Square Test KW - Convenience Sample KW - Crossover Design KW - England KW - Expert Systems -- Methods KW - Fisher's Exact Test KW - Guideline Adherence KW - Knowledge Bases KW - McNemar's Test KW - Physician Attitudes KW - Power of a Test KW - Programming Languages -- Utilization KW - Questionnaires KW - Semi-Structured Interview KW - Software Design KW - Summated Rating Scaling KW - Wilcoxon Signed Rank Test KW - Human SP - 233 EP - 242 JO - Studies in Health Technology & Informatics JF - Studies in Health Technology & Informatics JA - STUD HEALTH TECHNOL INFORM VL - 139 PB - IOS Press SN - 0926-9630 AD - Department of Academic Oncology, UCL, London U2 - PMID: 18806332. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105689355&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105803841 T1 - Prognostic factors in metastatic breast cancer: successes and challenges toward individualized therapy. AU - Andreopoulou E AU - Hortobagyi GN Y1 - 2008/08//8/1/2008 N1 - Accession Number: 105803841. Language: English. Entry Date: 20080829. Revision Date: 20150711. Publication Type: Journal Article; editorial. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Oncologic Care. NLM UID: 8309333. KW - Antineoplastic Agents, Combined -- Therapeutic Use KW - Breast Neoplasms -- Drug Therapy KW - Patient Selection KW - Breast Neoplasms -- Pathology KW - Breast Neoplasms KW - Decision Support Systems, Clinical KW - Decision Support Techniques KW - Female KW - Genes KW - Neoplasm Metastasis KW - Neoplasm Staging KW - Treatment Outcomes KW - Tumor Markers, Biological -- Analysis SP - 3660 EP - 3662 JO - Journal of Clinical Oncology JF - Journal of Clinical Oncology JA - J CLIN ONCOL VL - 26 IS - 22 CY - Alexandria, Virginia PB - American Society of Clinical Oncology SN - 0732-183X U2 - PMID: 18669447. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105803841&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105680892 T1 - Association between temporal orientation and attitudes about BRCA1/2 testing among women of African descent with family histories of breast cancer. AU - Edwards TA AU - Thompson HS AU - Kwate NO AU - Brown K AU - McGovern MM AU - Forman A AU - Kapil-Pair N AU - Jandorf L AU - Bovbjerg DH AU - Valdimarsdottir HB AU - Edwards, Tiffany A AU - Thompson, Hayley S AU - Kwate, Naa Oyo A AU - Brown, Karen AU - McGovern, Margaret M AU - Forman, Andrea AU - Kapil-Pair, Nidhi AU - Jandorf, Lina AU - Bovbjerg, Dana H AU - Valdimarsdottir, Heiddis B Y1 - 2008/08// N1 - Accession Number: 105680892. Language: English. Entry Date: 20081031. Revision Date: 20161125. Publication Type: journal article; research. Journal Subset: Core Nursing; Europe; Health Promotion/Education; Nursing; Peer Reviewed; UK & Ireland. Grant Information: R25 CA081137-09/CA/NCI NIH HHS/United States. NLM UID: 8406280. KW - Blacks KW - Breast Neoplasms KW - Genetic Screening -- Methods KW - Genetic Screening -- Psychosocial Factors KW - Patient Attitudes -- Ethnology KW - Perception KW - Women -- Psychosocial Factors KW - Adult KW - Aged KW - Analysis of Variance KW - Attitude to Health KW - Breast Neoplasms -- Diagnosis KW - Disease Susceptibility KW - Female KW - Genes, BRCA KW - Middle Age KW - Multivariate Analysis KW - Mutation KW - New York KW - Orientation KW - Questionnaires KW - Regression KW - Socioeconomic Factors KW - Time Factors KW - Women -- Education KW - Human SP - 276 EP - 282 JO - Patient Education & Counseling JF - Patient Education & Counseling JA - PATIENT EDUC COUNS VL - 72 IS - 2 PB - Elsevier B.V. AB - Objective: Previous studies have identified specific attitudes (pros and cons) about BRCA testing held by women of African descent that are associated with decisions to participate in testing. These testing attitudes may be determined, in part, by temporal orientation, or how one perceives the significance of events and the consequences of their actions in terms of past, present, and future. The current study explored the relationship between temporal orientation and pros and cons of BRCA testing among 140 women of African descent with a family history suggestive of a genetic mutation predisposing to breast cancer.Methods: Participants completed measures of temporal orientation and genetic testing attitudes.Results: Multivariate analyses indicated that future orientation was positively associated with perceived pros of testing. Additional analyses revealed significant associations between temporal orientation and specific item subsets related to the negative and positive impact of testing on family and personal control over one's health.Conclusion: These results support an association between temporal orientation and attitudes about BRCA testing among women of African descent with family histories of breast cancer.Practice Implications: Findings support exploration of temporal orientation in future research on BRCA testing decisions among women of African descent and this construct's importance in developing decision aids and tailoring genetic counseling. SN - 0738-3991 AD - Mount Sinai School of Medicine, New York, NY 10029-6574, USA U2 - PMID: 18479882. DO - 10.1016/j.pec.2008.03.021 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105680892&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105657640 T1 - Support needs and acceptability of psychological and peer consultation: attitudes of 108 women who had undergone or were considering prophylactic mastectomy. AU - Patenaude AF AU - Orozco S AU - Li X AU - Kaelin CM AU - Gadd M AU - Matory Y AU - Mayzel K AU - Roche CA AU - Smith BL AU - Farkas W AU - Garber JE AU - Patenaude, Andrea F AU - Orozco, Sara AU - Li, Xiaochun AU - Kaelin, Carolyn M AU - Gadd, Michelle AU - Matory, Yvedt AU - Mayzel, Kathleen AU - Roche, Constance A AU - Smith, Barbara L Y1 - 2008/08// N1 - Accession Number: 105657640. Language: English. Entry Date: 20081003. Revision Date: 20161115. Publication Type: journal article; research; tables/charts. Journal Subset: Biomedical; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care; Psychiatry/Psychology; Women's Health. Instrumentation: Prophylactic Mastectomy Interview. Grant Information: 1 RO3 HG003051/HG/NHGRI NIH HHS/United States. NLM UID: 9214524. KW - Breast Neoplasms -- Prevention and Control KW - Breast Neoplasms -- Psychosocial Factors KW - Mastectomy KW - Mental Health Services KW - Patient Attitudes KW - Referral and Consultation KW - Support, Psychosocial KW - Adult KW - Aged KW - Aged, 80 and Over KW - Breast Neoplasms -- Familial and Genetic KW - Breast Neoplasms -- Risk Factors KW - Cross Sectional Studies KW - Decision Making, Patient KW - Descriptive Statistics KW - Female KW - Funding Source KW - Interview Guides KW - Middle Age KW - Narratives KW - Needs Assessment KW - Psychotherapy KW - Questionnaires KW - Record Review KW - Retrospective Design KW - Semi-Structured Interview KW - Human SP - 831 EP - 843 JO - Psycho-Oncology JF - Psycho-Oncology JA - PSYCHO ONCOL VL - 17 IS - 8 CY - Hoboken, New Jersey PB - John Wiley & Sons, Inc. AB - Objective: Prophylactic mastectomy (PM) offers 90% or greater reduction in risk of breast cancer to women at increased hereditary risk. Nonetheless, acceptance in North America is low (0-27%) and 25-50% of women electing surgery report psychological distress and/or difficulty adapting following PM. Most women also report reduced cancer worry postoperatively. Psychological consultation to aid decision-making and post-surgical coping is not routinely offered. This retrospective, cross-sectional study explored interest in and acceptability of psychological consultation for issues related to PM among 108 women who had undergone or were considering surgery.Method: Qualitative interviews were conducted with 26 healthy women who had undergone prophylactic mastectomy of both (bilateral) breasts (BPM), 45 women who had undergone prophylactic mastectomy of one breast (unilateral contralateral) (UPM) after diagnosis of invasive breast cancer in the other breast or ductal carcinoma in situ (DCIS), and 37 women who were considering having PM surgery.Results: Of the women who had undergone PM, more than half felt pre-surgical psychological consultation was advisable; nearly 2/3 thought post-surgical psychological consultation would be helpful. All women currently considering PM believed psychological consultation would aid decision-making and preparation for surgery. Strong support was reported in all groups for the emotional and informational value of speaking with a woman who had previously undergone PM.Conclusions: Narratives illustrate the nature and intensity of the need for psychological support and describe preferences for the role of the psychologist. Suggestions are offered for integration of psychological services for women deciding about or adapting to PM. SN - 1057-9249 AD - Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA. andrea U2 - PMID: 18636423. DO - 10.1002/pon.1279 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105657640&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105657641 T1 - A randomized trial of a breast/ovarian cancer genetic testing decision aid used as a communication aid during genetic counseling. AU - Wakefield CE AU - Meiser B AU - Homewood J AU - Taylor A AU - Gleeson M AU - Williams R AU - Tucker K Y1 - 2008/08// N1 - Accession Number: 105657641. Corporate Author: AGenDA Collaborative Group. Language: English. Entry Date: 20081003. Revision Date: 20150711. Publication Type: Journal Article; clinical trial; research; tables/charts. Journal Subset: Biomedical; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care; Psychiatry/Psychology; Women's Health. Instrumentation: Impact of Events Scale (IES); Hospital Anxiety and Depression Scale (HADS); Decisional Conflict Scale (DCS). Grant Information: Funded by The Cancer Council of New South Wales, and an Australian Postgraduate Award and by National Health and Medical Research Council of Australia. NLM UID: 9214524. KW - Breast Neoplasms -- Diagnosis KW - Breast Neoplasms -- Familial and Genetic KW - Decision Making, Patient KW - Decision Support Techniques -- Utilization KW - Genetic Counseling KW - Genetic Screening KW - Ovarian Neoplasms -- Diagnosis KW - Ovarian Neoplasms -- Familial and Genetic KW - Adult KW - Aged KW - Australia KW - Breast Neoplasms -- Psychosocial Factors KW - Chi Square Test KW - Clinical Trials KW - Communication KW - Data Analysis Software KW - Descriptive Statistics KW - Effect Size KW - Family Role KW - Female KW - Funding Source KW - Health Knowledge KW - Impact of Events Scale KW - Logistic Regression KW - Middle Age KW - Ovarian Neoplasms -- Psychosocial Factors KW - Post Hoc Analysis KW - Psychological Tests KW - Questionnaires KW - Referral and Consultation KW - Scales KW - Summated Rating Scaling KW - Human SP - 844 EP - 854 JO - Psycho-Oncology JF - Psycho-Oncology JA - PSYCHO ONCOL VL - 17 IS - 8 CY - Hoboken, New Jersey PB - John Wiley & Sons, Inc. AB - Objectives: To evaluate the impact of a decision aid for women considering genetic testing for breast/ovarian cancer risk given during genetic counseling. Methods: One hundred and forty-eight women were randomized to receive the decision aid or a control pamphlet at the beginning of their first consultation with a genetic counselor. When the patient received the decision aid, it was used to complement consultation discussions about genetic testing. One hundred and ten (74.3%) women completed the first questionnaire designed to elicit information about women's levels of decisional conflict and knowledge about genetic testing. Of these, 105 (70.9%) completed a second questionnaire to assess longer-term outcomes, 6 months postconsultation. Results: Results showed that women who received the decision aid felt more informed about genetic testing ([chi]2(1)=8.69; P=0.003), had clearer values ([chi]2(1)=6.90; P=0.009) and had higher knowledge levels ([chi]2(2)=6.49; P=0.039) than women who received the control pamphlet. Conclusions: The developed decision aid improved patient outcomes better than a control pamphlet when implemented during genetic counseling and given to the patient to take home. Copyright © 2008 John Wiley & Sons, Ltd. SN - 1057-9249 AD - Department of Psychology, Macquarie University, NSW, Australia U2 - PMID: 18613319. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105657641&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105565004 T1 - Detecting nonpalpable recurrent breast cancer: the role of routine mammographic screening of transverse rectus abdominis myocutaneous flap reconstructions. AU - Lee JM AU - Georgian-Smith D AU - Gazelle GS AU - Halpern EF AU - Rafferty EA AU - Moore RH AU - Yeh ED AU - D'Alessandro HA AU - Hitt RA AU - Kopans DB AU - Lee, Janie M AU - Georgian-Smith, Dianne AU - Gazelle, G Scott AU - Halpern, Elkan F AU - Rafferty, Elizabeth A AU - Moore, Richard H AU - Yeh, Eren D AU - D'Alessandro, Helen A AU - Hitt, Rachel A AU - Kopans, Daniel B Y1 - 2008/08// N1 - Accession Number: 105565004. Language: English. Entry Date: 20090515. Revision Date: 20170404. Publication Type: journal article; research. Journal Subset: Biomedical; USA. Special Interest: Diagnostic Imaging. NLM UID: 0401260. KW - Abdominal Muscles -- Transplantation KW - Breast Neoplasms -- Radiography KW - Breast Neoplasms -- Surgery KW - Breast Reconstruction KW - Neoplasm Recurrence, Local -- Radiography KW - Surgical Flaps KW - Adult KW - Aged KW - Breast Neoplasms -- Mortality KW - Decision Support Techniques KW - Female KW - Mammography KW - Mastectomy KW - Middle Age KW - Retrospective Design KW - Treatment Outcomes KW - Human SP - 398 EP - 405 JO - Radiology JF - Radiology JA - RADIOLOGY VL - 248 IS - 2 CY - Oak Brook, Illinois PB - Radiological Society of North America AB - Purpose: To perform a retrospective cohort study to determine the rates of recall and cancer detection and then to develop a decision analytic model to evaluate the effectiveness of routine screening of transverse rectus abdominis myocutaneous (TRAM) flap reconstructions. Materials and Methods: This study was approved by the institutional review board, and the methods comply with HIPAA regulations. A retrospective search of the institutional mammographic results database was done to identify bilateral screening mammographic examinations obtained from January 1, 1999, through July 15, 2005. The search included the term TRAM; the recall and cancer detetion rates were then detected. Subsequently, a decision analytic model was constructed to evaluate a hypothetical cohort of women with TRAM flap reconstructions. Results: Of 554 mammograms (265 TRAM flap reconstructions), 546 (98.6%) had negative results (Breast Imaging Reporting and Data System category 1 or 2). Eight (1.4%) had positive test results (Breast Imaging Reporting and Data System category 0, 3, 4, or 5). All suspicious lesions underwent biopsy and had benign pathologic results. No interval breast cancers were identified. The detection rate for nonpalpable recurrent breast cancer was 0% (exact 95% confidence interval: 0.0%, 1.4%). According to decision analysis, screening would help detect an estimated 12 additional recurrent cancers per 1000 women screened, providing an additional 1.6 days of life expectancy for the screened cohort. Under base-case conditions, screening of TRAM flap reconstructions is less effective than screening asymptomatic women in their 40s. Sensitivity analysis revealed that a benefit equivalent to that of screening asymptomatic women in their 40s was achievable under conditions related to estimates of screening effectiveness and cancer detection rate. Conclusion: Routine screening mammography of TRAM flap reconstructions has a very low detection rate for nonpalpable recurrent breast cancer. Decision analysis indicates that screening such women is less effective than screening asymptomatic women in their 40s for primary breast cancer. SN - 0033-8419 AD - Department of Radiology, Massachusetts General Hospital, 101 Merrimac St, 10th Floor, Boston, MA 02114, USA U2 - PMID: 18539887. DO - 10.1148/radiol.2482071635 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105565004&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105759132 T1 - 'Stemness' genomics law governs clinical behavior of human cancer: implications for decision making in disease management. AU - Glinsky GV Y1 - 2008/06/10/ N1 - Accession Number: 105759132. Language: English. Entry Date: 20080704. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Oncologic Care. NLM UID: 8309333. KW - Genes KW - Genetics -- Methods KW - Models, Biological KW - Neoplasms -- Therapy KW - Patient Selection KW - Stem Cells -- Pathology KW - Algorithms KW - Breast Neoplasms KW - Breast Neoplasms -- Pathology KW - Breast Neoplasms -- Therapy KW - Decision Support Techniques KW - Drug Resistance, Neoplasm KW - Female KW - Genetic Screening KW - Genetic Techniques KW - Genotype KW - Lung Neoplasms KW - Lung Neoplasms -- Pathology KW - Lung Neoplasms -- Therapy KW - Male KW - Neoplasms KW - Neoplasms -- Metabolism KW - Neoplasms -- Pathology KW - Ovarian Neoplasms KW - Ovarian Neoplasms -- Pathology KW - Ovarian Neoplasms -- Therapy KW - Phenotype KW - Prostatic Neoplasms KW - Prostatic Neoplasms -- Pathology KW - Prostatic Neoplasms -- Therapy KW - Proteins -- Metabolism KW - Reproducibility of Results KW - Human SP - 2846 EP - 2853 JO - Journal of Clinical Oncology JF - Journal of Clinical Oncology JA - J CLIN ONCOL VL - 26 IS - 17 CY - Alexandria, Virginia PB - American Society of Clinical Oncology AB - One of the most significant accomplishments of translational oncogenomics is a realistic promise of efficient diagnostic tests that would facilitate implementation of the concept of individualized cancer therapies. Recent discovery of the BMI1 pathway rule indicates that gene expression signatures (GESs) associated with the 'stemness' state of a cell might be informative as molecular predictors of cancer therapy outcome. We illustrate a potential clinical utility of this concept using GESs derived from genomic analysis of embryonic stem cells (ESCs) during transition from self-renewing, pluripotent state to differentiated phenotypes. Signatures of multiple stemness pathways (signatures of BMI1, Nanog/Sox2/Oct4, EED, and Suz12 pathways; transposon exclusion zones and ESC pattern 3 signatures; signatures of Polycomb-bound and bivalent chromatin domain transcription factors) seem informative in stratification of cancer patients into low- and high-intensity treatment groups on the basis of prediction of the long-term therapy outcome. A stemness cancer therapy outcome predictor (CTOP) algorithm combining scores of nine stemness signatures outperforms individual signatures and demonstrates a superior prognostic accuracy in retrospective supervised analysis of large cohorts of breast, prostate, lung, and ovarian cancer patients. Our analysis suggests that stemness genomics law governs clinical behavior of human malignancies and defines epigenetic boundaries of therapy-resistant and -sensitive tumors within distinct stemness/differentiation programs. One of the main conclusions of our analysis is that near-term progress in practical implementation of the concept of personalized cancer therapies would depend on timely delivery to practicing physicians of relevant scientific information regarding the outcome of prospective trials validating prognostic performance of CTOP tests in a clinical setting. SN - 0732-183X AD - Translational & Functional Genomics Laboratory, Ordway Research Institute, Ordway Cancer Center, Center for Medical Science, 150 New Scotland Ave, Albany, NY 12208, USA. gglinsky@ordwayresearch.org U2 - PMID: 18539963. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105759132&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105803200 T1 - Basal breast cancer molecular subtype predicts for lower incidence of axillary lymph node metastases in primary breast cancer. AU - Crabb SJ AU - Cheang MC AU - Leung S AU - Immonen T AU - Nielsen TO AU - Huntsman DD AU - Bajdik CD AU - Chia SK Y1 - 2008/06//2008 Jun N1 - Accession Number: 105803200. Language: English. Entry Date: 20080829. Revision Date: 20150711. Publication Type: Journal Article. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Oncologic Care. NLM UID: 100898731. KW - Breast Neoplasms -- Pathology KW - Adult KW - Aged KW - Aged, 80 and Over KW - Axilla KW - Breast Neoplasms -- Classification KW - Breast Neoplasms KW - Female KW - Incidence KW - Middle Age KW - Neoplasm Metastasis KW - Proteins -- Analysis KW - Receptors, Cell Surface -- Analysis SP - 249 EP - 256 JO - Clinical Breast Cancer JF - Clinical Breast Cancer JA - CLIN BREAST CANCER VL - 8 IS - 3 CY - New York, New York PB - Elsevier B.V. AB - BACKGROUND: Axillary lymph node involvement remains the most important prognostic factor in early-stage breast cancer. We hypothesized that molecular classification based on breast cancer biology would predict the presence of nodal involvement at diagnosis, which might aid treatment decisions regarding the axilla. PATIENTS AND METHODS: From a clinically annotated tissue microarray of 4444 early-stage breast cancers, expression of estrogen receptor (ER), progesterone receptor (PgR), HER2, epidermal growth factor receptor, and cytokeratin 5/6 was determined by immunohistochemistry. Cases were classified by published criteria into molecular subtypes of luminal, luminal/HER2 positive, HER2 positive/ER negative/PgR negative, and basal. Risk of axillary nodal involvement at diagnosis was determined in 2 multivariable logistic regression models: a 'core biopsy model' including molecular subtype, age, grade, and tumor size and a 'lumpectomy model,' which also included lymphovascular invasion. Luminal was used as the reference group. After internal validation of findings in 2 independent sets, we conducted combined analysis of both. RESULTS: In the core biopsy model, the molecular subtypes had a predictive effect for nodal involvement (P= .000001), with the basal subtype having an odds ratio for axillary lymph node involvement of 0.53 (95% CI, 0.41-0.69). Tumor grade (P=5.43 x 10(-12)) and size (P=8.52 x 10(-35)) were also predictive for nodal involvement. Similar results were found in the lumpectomy model, where lymphovascular invasion was also predictive (P=2.74 x 10(-115)). CONCLUSION: These results indicate that the basal breast cancer molecular subtype predicts a lower incidence of axillary nodal involvement, and including biomarker profiles to predict nodal status at diagnosis could help stratification for decisions regarding axillary surgery and locoregional radiation. SN - 1526-8209 AD - Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada. U2 - PMID: 18650155. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105803200&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105742291 T1 - Pharmacogenomic variation of CYP2D6 and the choice of optimal adjuvant endocrine therapy for postmenopausal breast cancer: a modeling analysis. AU - Punglia RS AU - Burstein HJ AU - Winer EP AU - Weeks JC AU - Punglia, Rinaa S AU - Burstein, Harold J AU - Winer, Eric P AU - Weeks, Jane C Y1 - 2008/05/07/ N1 - Accession Number: 105742291. Language: English. Entry Date: 20080613. Revision Date: 20161125. Publication Type: journal article; research. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Oncologic Care. Grant Information: 1K07 CA118629/CA/NCI NIH HHS/United States. NLM UID: 7503089. KW - Antineoplastic Agents, Hormonal -- Therapeutic Use KW - Aromatase Inhibitors -- Therapeutic Use KW - Breast Neoplasms -- Drug Therapy KW - Breast Neoplasms KW - Estrogen Receptor Modulators -- Therapeutic Use KW - Oxidoreductases KW - Postmenopause KW - Probability KW - Tamoxifen -- Therapeutic Use KW - Aged KW - Chemotherapy, Adjuvant KW - Decision Support Techniques KW - Female KW - Genotype KW - Middle Age KW - Mutation KW - Neoplasms, Hormone-Dependent -- Drug Therapy KW - Odds Ratio KW - Prognosis KW - Proteins -- Analysis KW - Selective Estrogen Receptor Modulators -- Therapeutic Use KW - Human SP - 642 EP - 648 JO - JNCI: Journal of the National Cancer Institute JF - JNCI: Journal of the National Cancer Institute JA - J NATL CANCER INST VL - 100 IS - 9 PB - Oxford University Press / USA AB - Background: Adjuvant endocrine treatment with aromatase inhibitors improves disease-free survival compared with tamoxifen in postmenopausal women with estrogen receptor-positive breast cancer. This difference could be due to differences in tamoxifen metabolism because levels of endoxifen, the active tamoxifen metabolite, vary with the number of mutant alleles, including the *4 allele, of the gene encoding cytochrome P450 2D6 (CYP2D6).Methods: We created a Markov model to determine whether tamoxifen or aromatase inhibitor monotherapy maximized 5-year disease-free survival for patients with the wild-type CYP2D6 genotype (wt/wt). Annual risks of recurrence with aromatase inhibitors and tamoxifen in breast cancer patients who were not selected by CYP2D6 genotype were derived from the Breast International Group 1-98 trial. Genotype frequencies and the hazard ratio for cancer recurrence on tamoxifen among patients with the *4/*4 genotype relative to the wt/wt or wt/*4 genotypes (HR(*4/*4) = 1.86) were based on data from an analysis of the North Central Cancer Treatment Group trial of adjuvant tamoxifen. We explored the impact of CYP2D6(*4) heterozygosity on disease-free survival for wt/wt patients by studying a range of effect (ie, recurrence on tamoxifen) estimates, from no effect of the single mutation (Eff(wt/*4) = 0, recurrence rate in wt/*4 patients same as that in wt/wt patients) to complete effect (Eff(wt/*4) = 1 recurrence rate in wt/*4 patients same as that in *4/*4 patients).Results: With HR(*4/*4) = 1.86 and Eff(wt/*4) = 0.5, the 5-year disease-free survival of tamoxifen-treated patients with no mutations (wt/wt) was 83.9%, that is, essentially the same as that (84.0%) for genotypically unselected patients who were treated with aromatase inhibitors. With greater HR(*4/*4) estimates, disease-free survival with tamoxifen exceed that with aromatase inhibitors in wt/wt patients, even at lower assumed Eff(wt/*4) ratios.Conclusions: Modeling suggests that among patients who are wild type for CYP2D6, 5-year disease-free survival outcomes are similar to or perhaps even superior with tamoxifen than with aromatase inhibitors. Endocrine therapy tailored to CYP2D6 genotype could be considered for women who are newly diagnosed with breast cancer, particularly those who have with concerns about either the relative toxicity or the increased cost of aromatase inhibitors. SN - 0027-8874 AD - Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, 44 Binney St, Boston, MA 02115, USA AD - Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, 44 Binney St, Boston, MA 02115, USA. rpunglia@partners.org U2 - PMID: 18445827. DO - 10.1093/jnci/djn100 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105742291&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105735446 T1 - Latina a Latina: developing a breast cancer decision support intervention. AU - Sheppard VB AU - Figueiredo M AU - Cañar J AU - Goodman M AU - Caicedo L AU - Kaufman A AU - Norling G AU - Mandelblatt J Y1 - 2008/04// N1 - Accession Number: 105735446. Language: English. Entry Date: 20080606. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care; Psychiatry/Psychology. NLM UID: 9214524. KW - Breast Neoplasms -- Psychosocial Factors KW - Decision Making KW - Hispanics -- Psychosocial Factors KW - Peer Group KW - Support, Psychosocial KW - Adult KW - Aged KW - Breast Neoplasms -- Drug Therapy KW - Chemotherapy, Adjuvant -- Psychosocial Factors KW - Communication KW - Cultural Competence KW - Culture KW - Female KW - Health Behavior KW - Mentorship KW - Middle Age KW - Patient Education KW - Pilot Studies KW - Problem Solving KW - Self-Efficacy KW - Survivors -- Psychosocial Factors KW - Human SP - 383 EP - 391 JO - Psycho-Oncology JF - Psycho-Oncology JA - PSYCHO ONCOL VL - 17 IS - 4 CY - Hoboken, New Jersey PB - John Wiley & Sons, Inc. AB - Latinas have the fastest rising incidence of breast cancer. Yet, little data are available about Latinas' breast cancer treatment experiences. Aims were to: (1) identify factors in Latinas' treatment decision making and (2) develop and pilot a decision support intervention. Thirty-seven Latinas diagnosed with breast cancer participated. Qualitative data were used to identify intervention messages. Most women desired help in asking questions. Women were most concerned about chemotherapy side effects. Cultural values (e.g. personalismo, familismo) helped structure intervention messages. In phase two, participants completed a face-to-face skill-building session with a trained breast cancer survivor. Women found the intervention acceptable and reported better communication and decision-making skills. Interventions that focus on cultural strengths may improve Latinas treatment experiences and informed decision making. SN - 1057-9249 AD - Cancer Control Program, Georgetown University, Washington, DC, USA. U2 - PMID: 17628037. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105735446&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105797645 T1 - Methodological issues in evaluating cost effectiveness of adjuvant aromatase inhibitors in early breast cancer: a need for improved modelling to aid decision making. AU - Annemans L AU - Annemans, Lieven Y1 - 2008/03/15/ N1 - Accession Number: 105797645. Language: English. Entry Date: 20080822. Revision Date: 20171116. Publication Type: journal article; research; review. Journal Subset: Australia & New Zealand; Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed. NLM UID: 9212404. KW - Aromatase Inhibitors -- Economics KW - Aromatase Inhibitors -- Therapeutic Use KW - Breast Neoplasms -- Drug Therapy KW - Breast Neoplasms -- Economics KW - Aromatase Inhibitors -- Adverse Effects KW - Cost Benefit Analysis KW - Economics, Pharmaceutical -- Statistics and Numerical Data KW - Female KW - Models, Statistical KW - Risk Assessment SP - 409 EP - 423 JO - PharmacoEconomics JF - PharmacoEconomics JA - PHARMACOECONOMICS VL - 26 IS - 5 PB - Springer Science & Business Media B.V. AB - The optimal adjuvant hormonal strategy in post-menopausal women with early breast cancer is a subject of ongoing debate. Aromatase inhibitors (AIs) have been successfully evaluated in clinical trials that have compared them with a standard treatment of 5 years of tamoxifen. However, several options are available in terms of treatment schedule and selected drug. Systematic reviews of clinical trials and health economic evaluations attempt to contribute to the debate. The objective of this paper is to provide a critical review of existing health economic evaluations with a focus on those parameters and assumptions with the largest impact on final outcomes.A wide range of different inputs and assumptions exist, which make a comparison of results difficult, if not impossible. In particular, the modelling of recurrence rates over longer time horizons than those observed in clinical trials, a cornerstone of health economic modelling, is subject to quite different approaches. The practice of indirect comparison of different AIs without sufficiently acknowledging population differences is also bothersome. A list of key features (related to time horizon, clinical data input, patient subtypes, budget impact and model calibration) that an ideal model should have in order to better assist decision makers in this field is proposed. SN - 1170-7690 AD - Department of Public Health, Ghent University, Ghent, Belgium AD - Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Ghent, BelgiumFaculty of Medicine and Pharmacy, Brussels University, Brussels, Belgium. U2 - PMID: 18429657. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105797645&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105736019 T1 - An integrated framework for risk profiling of breast cancer patients following surgery. AU - Jarman IH AU - Etchells TA AU - Martín JD AU - Lisboa PJ Y1 - 2008/03// N1 - Accession Number: 105736019. Language: English. Entry Date: 20080606. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Blind Peer Reviewed; Computer/Information Science; Continental Europe; Europe; Expert Peer Reviewed; Peer Reviewed. Special Interest: Informatics. NLM UID: 8915031. KW - Breast Neoplasms -- Surgery KW - Decision Support Systems, Clinical KW - Decision Support Techniques KW - Mastectomy KW - Patient Selection KW - Adult KW - Algorithms KW - Artificial Intelligence KW - Breast Neoplasms -- Mortality KW - Confidence Intervals KW - Female KW - Health Status Indicators KW - Internet KW - Middle Age KW - Models, Biological KW - Neural Networks (Computer) KW - Prognosis KW - Reproducibility of Results KW - Retrospective Design KW - Risk Assessment KW - Systems Analysis KW - Treatment Outcomes KW - User-Computer Interface KW - Human SP - 165 EP - 188 JO - Artificial Intelligence in Medicine JF - Artificial Intelligence in Medicine JA - ARTIF INTELL MED VL - 42 IS - 3 PB - Elsevier B.V. SN - 0933-3657 AD - School of Computing and Mathematical Sciences, Liverpool John Moores University, Byrom Street, Liverpool L3 3AF, UK. i.h.jarman@ljmu.ac.uk U2 - PMID: 18242967. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105736019&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105901004 T1 - Implementing breast cancer decision aids in community sites: barriers and resources. AU - Silvia KA AU - Ozanne EM AU - Sepucha KR Y1 - 2008/03// N1 - Accession Number: 105901004. Language: English. Entry Date: 20080425. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Europe; Health Services Administration; Peer Reviewed; UK & Ireland. NLM UID: 9815926. KW - Breast Neoplasms -- Psychosocial Factors KW - Consumer Participation -- Methods KW - Decision Making KW - Decision Support Techniques KW - Professional-Patient Relations KW - Breast Neoplasms -- Therapy KW - Community Health Services KW - Female KW - Interviews KW - Massachusetts KW - Patient Education -- Methods KW - Pilot Studies KW - Program Development KW - Videorecording KW - Human SP - 46 EP - 53 JO - Health Expectations JF - Health Expectations JA - HEALTH EXPECTATIONS VL - 11 IS - 1 CY - Malden, Massachusetts PB - Wiley-Blackwell AB - Objective To assess the feasibility of implementing four patient decision aids (PtDAs) for early stage breast cancer treatment decisions into routine clinical care in community settings. Background There is very limited information available about implementing decision aids into routine clinical practice and most of this information is based on academic centres; more information is needed about implementing them into routine clinical practice in community settings. Design Structured individual interviews. Setting and participants Providers from 12 sites, including nine community hospitals, a community oncology centre and two academic centres. Main outcome measures Usage data, barriers to and resources for implementing the PtDAs. Results Nine of the 12 sites were using the PtDAs with patients. All of the sites were lending the PtDAs to patients, usually without a formal sign-out system. The keys to successful implementation included nurses' and social workers' interest in distributing the PtDAs and the success of the lending model. Barriers that limited or prevented sites from using the PtDA included a lack of physician support, a lack of an organized system for distributing the PtDAs and nurses' perceptions about patients' attitude towards participation in decision making. Conclusions It is feasible to implement PtDAs for early stage breast cancer into routine clinical care in community settings, even with few resources available. SN - 1369-6513 AD - Suffolk University, Boston, MA, USA. U2 - PMID: 18275401. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105901004&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105691283 T1 - Breast cancer screening in BRCA1 mutation carriers: effectiveness of MR imaging--Markov Monte Carlo decision analysis. AU - Lee JM AU - Kopans DB AU - McMahon PM AU - Halpern EF AU - Ryan PD AU - Weinstein MC AU - Gazelle GS AU - Lee, Janie M AU - Kopans, Daniel B AU - McMahon, Pamela M AU - Halpern, Elkan F AU - Ryan, Paula D AU - Weinstein, Milton C AU - Gazelle, G Scott Y1 - 2008/03// N1 - Accession Number: 105691283. Language: English. Entry Date: 20081114. Revision Date: 20161115. Publication Type: journal article; research. Journal Subset: Biomedical; USA. Special Interest: Diagnostic Imaging. Grant Information: R25 CA092203/CA/NCI NIH HHS/United States. NLM UID: 0401260. KW - Breast Neoplasms -- Diagnosis KW - Breast Neoplasms KW - Health Screening -- Methods KW - Magnetic Resonance Imaging -- Methods KW - Probability KW - Systems Analysis KW - Adult KW - Breast Neoplasms -- Mortality KW - Female KW - Genes, BRCA KW - Life Expectancy KW - Mammography KW - Registries, Disease KW - United States SP - 763 EP - 771 JO - Radiology JF - Radiology JA - RADIOLOGY VL - 246 IS - 3 CY - Oak Brook, Illinois PB - Radiological Society of North America AB - Purpose: To project intermediate and long-term clinical outcomes of magnetic resonance (MR) imaging screening for breast cancer in women with BRCA1 gene mutations.Materials and Methods: A microsimulation model was developed to compare three annual screening strategies versus clinical surveillance: (a) mammography, (b) MR imaging, and (c) combined MR imaging and mammography. Input parameters were obtained from the published medical literature, existing databases, and expert opinion. The model was calibrated to targets from the Surveillance Epidemiology and End Results database (1975-1980) compiled during a period prior to the onset of widespread mammographic screening. Sensitivity analysis was performed to evaluate the effect of uncertainty in parameter estimates.Results: With clinical surveillance, the estimated median diameter of invasive breast cancers at presentation was 2.6 cm. Average life expectancy was 71.15 years. With annual screening with mammography, MR imaging, or combined mammography and MR imaging, median invasive tumor diameters at diagnosis decreased to 1.9, 1.3, and 1.1 cm, respectively. Annual screening with mammography, MR imaging, or combined mammography and MR imaging increased average life expectancy by 0.80 year, 1.10 years, and 1.38 years, respectively, and decreased relative mortality from breast cancer (16.8%, 17.2%, and 22.0%, respectively). Program sensitivity was greater than 50% only with MR imaging screening strategies. The majority of women undergoing screening had one or more false-positive screening examinations (53.8%, 80.2%, and 84.0% for mammography, MR imaging, and combined mammography and MR imaging, respectively). Many women also underwent one or more biopsies for benign disease (11.3%, 26.3%, and 30.3%, respectively). Results were sensitive to BRCA1 penetrance estimates and to MR imaging sensitivity in the detection of ductal carcinoma in situ.Conclusion: Annual screening with combined mammography and MR imaging provides BRCA1 mutation carriers with the greatest life expectancy gain and breast cancer mortality reduction. However, an important trade-off of this strategy is an increased rate of false-positive screening results and biopsies performed for benign disease. SN - 0033-8419 AD - Department of Radiology, Institute for Technology Assessment, Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, 101 Merrimac St, 10th Floor, Boston, MA 02114, USA AD - Department of Radiology, Institute for Technology Assessment, Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, 101 Merrimac St, 10th Floor, Boston, MA 02114, USA. jlee45@partners.org U2 - PMID: 18309013. DO - 10.1148/radiol.2463070224 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105691283&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105862233 T1 - Docetaxel in combination with doxorubicin and cyclophosphamide as adjuvant treatment for early node-positive breast cancer: a cost-effectiveness and cost-utility analysis. AU - Wolowacz SE AU - Cameron DA AU - Tate HC AU - Bagust A AU - Wolowacz, Sorrel E AU - Cameron, David A AU - Tate, Helen C AU - Bagust, Adrian Y1 - 2008/02/20/ N1 - Accession Number: 105862233. Language: English. Entry Date: 20080314. Revision Date: 20170413. Publication Type: journal article; research. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Oncologic Care. NLM UID: 8309333. KW - Antineoplastic Agents, Combined -- Economics KW - Antineoplastic Agents, Combined -- Therapeutic Use KW - Breast Neoplasms -- Drug Therapy KW - Breast Neoplasms -- Economics KW - Granulocyte Colony-Stimulating Factor -- Economics KW - Granulocyte Colony-Stimulating Factor -- Therapeutic Use KW - Lymph Nodes -- Pathology KW - Neutropenia -- Prevention and Control KW - Antineoplastic Agents, Combined -- Administration and Dosage KW - Antineoplastic Agents, Combined -- Adverse Effects KW - Axilla KW - Breast Neoplasms -- Pathology KW - Breast Neoplasms -- Surgery KW - Chemotherapy, Adjuvant KW - Cost Benefit Analysis KW - Cyclophosphamide -- Administration and Dosage KW - Cyclophosphamide -- Economics KW - Decision Trees KW - Doxorubicin -- Administration and Dosage KW - Doxorubicin -- Economics KW - Female KW - Fluorouracil -- Administration and Dosage KW - Fluorouracil -- Economics KW - Great Britain KW - Hydrocarbons -- Administration and Dosage KW - Hydrocarbons -- Economics KW - Kaplan-Meier Estimator KW - Life Table Method KW - Neoplasm Metastasis KW - Neoplasm Staging KW - Neutropenia -- Chemically Induced KW - Preventive Health Care -- Economics KW - Preventive Health Care KW - Probability KW - Prognosis KW - Human SP - 925 EP - 933 JO - Journal of Clinical Oncology JF - Journal of Clinical Oncology JA - J CLIN ONCOL VL - 26 IS - 6 CY - Alexandria, Virginia PB - American Society of Clinical Oncology AB - Purpose: To estimate the cost effectiveness of TAC (docetaxel, doxorubicin, and cyclophosphamide) compared with FAC (fluorouracil, doxorubicin, and cyclophosphamide) when administered as adjuvant therapy to women with node-positive early breast cancer in the United Kingdom (UK), both with and without primary prophylaxis with granulocyte colony-stimulating factor (G-CSF). Methods: A standard health economic Markov model estimated the cost and outcome for node-positive early breast cancer patients, from initiation of adjuvant chemotherapy to death. Patient-level data were used from the Breast Cancer International Research Group (BCIRG) 001 trial for estimates of the effect of chemotherapy on toxicity and outcome, and an observational data set collected from a UK university hospital provided estimates of resource use and outcome for patients with relapsed disease. Results: Over a 10-year analysis timeframe, the incremental cost per life-year saved associated with the use of TAC rather than FAC was estimated as pound 15,418 (95% CI, pound 13,734 to pound 17,997) and the incremental cost per quality-adjusted life-year gained (IC/QALY) was pound 18,188 (95% CI, pound 14,161 to pound 32,422). The addition of primary G-CSF (lenograstim or filgrastim) to the TAC regimen resulted in an IC/QALY of pound 20,432. The results were most sensitive to the quality-of-life (QOL) score for patients in remission postchemotherapy. However, even if QOL was assumed to be as poor as for patients with metastatic disease, the IC/QALY estimate rose only to pound 32,430. Conclusion: The use of adjuvant TAC rather than FAC for node-positive early breast cancer patients is cost effective, despite the increased drug and toxicity treatment costs, and when primary G-CSF prophylaxis is given to all patients. SN - 0732-183X AD - RTI-Health Solutions, Williams House, University of Manchester Science Park, Manchester M15 6SE, United Kingdom AD - RTI-Health Solutions, Williams House, University of Manchester Science Park, Manchester M15 6SE, United Kingdom. swolowacz@rti.org U2 - PMID: 18281666. DO - 10.1200/JCO.2006.10.4190 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105862233&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105788159 T1 - Can pharmacoeconomics and outcomes research contribute to the empowerment of women affected by breast cancer? AU - Lee JT AU - Bridges JFP AU - Shockney L Y1 - 2008/02// N1 - Accession Number: 105788159. Language: English. Entry Date: 20080815. Revision Date: 20171129. Publication Type: Journal Article; review. Journal Subset: Biomedical; Europe; UK & Ireland. Special Interest: Evidence-Based Practice. NLM UID: 101132257. KW - Breast Neoplasms -- Familial and Genetic KW - Decision Making, Patient KW - Empowerment KW - Genetic Screening -- Economics KW - Women KW - Breast Neoplasms -- Psychosocial Factors KW - Cost Benefit Analysis KW - Genes, BRCA KW - Quality of Life SP - 73 EP - 79 JO - Expert Review of Pharmacoeconomics & Outcomes Research JF - Expert Review of Pharmacoeconomics & Outcomes Research JA - EXPERT REV PHARMACOECON OUTCOMES RES VL - 8 IS - 1 CY - Philadelphia, Pennsylvania PB - Taylor & Francis Ltd AB - Breakthroughs in genetic testing have informed patients and physicians in the treatment of breast cancer; however, they have also added to the complexity of decision-making. Genetic testing for breast cancer susceptibility not only changes treatment and screening options, but also challenges the way in which interventions are evaluated. While comparative effectiveness and cost-effective analysis methods are now standard for evaluation at the societal level, technologies such as genetic testing require us to consider the role of patient preference, especially as we move towards more personalized approaches to medicine. In this review, we discuss the changing role of pharmacoeconomics and outcomes research by highlighting how the discipline could use patient preference methods, such as conjoint analysis, to promote shared decision-making and to empower breast cancer patients. By adopting these methods we could move our focus from what is best for payers or society to one that applies scientific methods to identify what is best for patients. SN - 1473-7167 AD - Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Rm 689, Baltimore, MD 21205, USA UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105788159&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105874116 T1 - Partial breast irradiation versus whole breast radiotherapy for early-stage breast cancer: a decision analysis. AU - Sher DJ AU - Wittenberg E AU - Taghian AG AU - Bellon JR AU - Punglia RS AU - Sher, David J AU - Wittenberg, Eve AU - Taghian, Alphonse G AU - Bellon, Jennifer R AU - Punglia, Rinaa S Y1 - 2008/02// N1 - Accession Number: 105874116. Language: English. Entry Date: 20080328. Revision Date: 20161125. Publication Type: journal article; research. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Oncologic Care. Grant Information: K07 CA118269-01/CA/NCI NIH HHS/United States. NLM UID: 7603616. KW - Breast Neoplasms -- Radiotherapy KW - Decision Support Techniques KW - Life Table Method KW - Adult KW - Age Factors KW - Breast Neoplasms -- Mortality KW - Breast Neoplasms -- Pathology KW - Breast Neoplasms KW - Female KW - Heterocyclic Compounds KW - Middle Age KW - Neoplasm Recurrence, Local -- Mortality KW - Neoplasm Staging KW - Organic Chemicals KW - Probability KW - Proteins -- Analysis KW - Human SP - 469 EP - 476 JO - International Journal of Radiation Oncology, Biology, Physics JF - International Journal of Radiation Oncology, Biology, Physics JA - INT J RADIAT ONCOL BIOL PHYS VL - 70 IS - 2 PB - Pergamon Press - An Imprint of Elsevier Science AB - Purpose: To compare the quality-adjusted life expectancy between women treated with partial breast irradiation (PBI) vs. whole breast radiotherapy (WBRT) for estrogen receptor-positive early-stage breast cancer.Methods and Materials: We developed a Markov model to describe health states in the 15 years after radiotherapy for estrogen receptor-positive early-stage breast cancer. Breast cancer recurrences were separated into local recurrences and elsewhere failures. Ipsilateral breast tumor recurrence (IBTR) risk was extracted from the Oxford overview, and rates and utilities were adapted from the literature. We studied two cohorts of women (aged 40 and 55 years), both of whom received adjuvant tamoxifen.Results: Assuming a no evidence of disease (NED)-PBI utility of 0.93, quality-adjusted life expectancy after PBI (and WBRT) was 12.61 (12.57) and 12.10 (12.06) years for 40-year-old and 55-year-old women, respectively. The NED-PBI utility thresholds for preferring PBI over WBRT were 0.923 and 0.921 for 40-year-old and 55-year-old women, respectively, both slightly greater than the NED-WBRT utility. Outcomes were sensitive to the utility of NED-PBI, the PBI hazard ratio for local recurrence, the baseline IBTR risk, and the percentage of IBTRs that were local. Overall the degree of superiority of PBI over WBRT was greater for 55-year-old women than for 40-year-old women.Conclusions: For most utility values of the NED-PBI health state, PBI was the preferred treatment modality. This result was highly sensitive to patient preferences and was also dependent on patient age, PBI efficacy, IBTR risk, and the fraction of IBTRs that were local. SN - 0360-3016 AD - Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA AD - Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA. U2 - PMID: 17967514. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105874116&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105885069 T1 - Interactive patient decision aids for women facing genetic testing for familial breast cancer: a systematic web and literature review. AU - Williams L AU - Jones W AU - Elwyn G AU - Edwards A Y1 - 2008/02// N1 - Accession Number: 105885069. Language: English. Entry Date: 20080411. Revision Date: 20150711. Publication Type: Journal Article. Journal Subset: Biomedical; Blind Peer Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; Public Health; UK & Ireland. Special Interest: Public Health. NLM UID: 9609066. KW - Breast Neoplasms KW - Decision Support Techniques KW - Genetic Screening -- Psychosocial Factors KW - Women -- Psychosocial Factors KW - Female KW - Internet SP - 70 EP - 74 JO - Journal of Evaluation in Clinical Practice JF - Journal of Evaluation in Clinical Practice JA - J EVAL CLIN PRACT VL - 14 IS - 1 CY - Malden, Massachusetts PB - Wiley-Blackwell AB - OBJECTIVE: A systematic review to identify and appraise interactive decision aids that are designed for consumer use, in the field of hereditary breast cancer and genetic testing. METHODS: An Internet (Google, Alta Vista) and literature search (Medline) was conducted for suitable decision aids. The decision aid had to (inclusion criteria): be about genetic testing for familial breast cancer; fulfil the criteria of a decision aid; use multimedia IT; be interactive (user does something that influences the decision pathway); and be for patient/public use. Exclusion criteria were decision aids that: had no interactivity (e.g. leaflet, video); discussed management decisions after gene status confirmed; non-English; aids that required membership/subscription. Once aids had been selected for further appraisal they were assessed against a recognized framework for the evaluation of decision aids--the International Patient Decision Aid Standards (IPDAS) criteria. RESULTS: On Google 595 web pages were assessed, as were 382 Google directory entries. Alta Vista revealed fewer results and revealed no new sites. Twenty-four web sites and four CD-ROMs with the most potential as stand alone decision aids were then selected for further assessment. On Medline 776 citations were reviewed, of these only one CD-ROM and no web sites were found. After initial appraisal only two CD-ROMs and one web site met the criteria for further consideration. Assessed against the IPDAS criteria, the decision aids scored poorly with no aid scoring more than 50%. CONCLUSIONS: Although there is a significant amount of interest in genetic testing to determine whether a woman is at high risk of breast cancer, the current genetic services are having difficulty coping with the demand. Alternatives such as decision aids have been suggested. There are many sources of information available, but few are truly interactive or designed for patient use. Of the three evaluated, all were from the USA and are likely to require modification for patients elsewhere. SN - 1356-1294 AD - Academic Fellow, Department of General Practice, Centre for Health Sciences Research, School of Medicine, Cardiff University, Cardiff, UK U2 - PMID: 18211647. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105885069&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105885074 T1 - Exploring the requirements for a decision aid on familial breast cancer in the UK context: a qualitative study with patients referred to a cancer genetics service. AU - Iredale R AU - Rapport F AU - Sivell S AU - Jones W AU - Edwards A AU - Gray J AU - Elwyn G Y1 - 2008/02// N1 - Accession Number: 105885074. Language: English. Entry Date: 20080411. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Blind Peer Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; Public Health; UK & Ireland. Special Interest: Public Health. NLM UID: 9609066. KW - Breast Neoplasms -- Psychosocial Factors KW - Breast Neoplasms KW - Decision Support Techniques KW - Genetic Counseling -- Psychosocial Factors KW - Genetic Screening -- Psychosocial Factors KW - Patient Attitudes KW - Adult KW - CD ROM KW - Female KW - Focus Groups KW - Pilot Studies KW - Qualitative Studies KW - Referral and Consultation KW - Wales KW - Human SP - 110 EP - 115 JO - Journal of Evaluation in Clinical Practice JF - Journal of Evaluation in Clinical Practice JA - J EVAL CLIN PRACT VL - 14 IS - 1 CY - Malden, Massachusetts PB - Wiley-Blackwell AB - RATIONALE: Patients concerned about a family history of breast cancer can face difficult decisions about screening, prophylactic surgery and genetic testing. Decision aids can facilitate patient decision making and currently include leaflets and computerized tools. These are largely aimed at the North American market. However, no decision aids concerning familial breast cancer exist in the UK. METHODS: Focus groups were held with 39 women over 18 years of age referred to a cancer genetics clinic, and who had been given a risk assessment for developing breast cancer. Each focus group examined three existing North American decision aids (1 paper-based and 2 CD-ROMs) and explored what a decision aid in a UK context should look like and the information it should contain. RESULTS: There was enthusiasm for the development of decision aids that suit the local context in terms of its health care policy, in paper-based and CD-ROM formats. This paper identifies areas of agreement and disagreement in terms of both content and presentation styles, and also reports some of the suggestions received about where, when and with whom decision aids should be used. Participants suggested that decision aids would be most effective when they allowed a user-selected range of formats. CONCLUSION: There is still significant unmet demand for information and decision support in the context of publicly funded health care. The patient perspective provides a unique insight into issues of design, style and communication. SN - 1356-1294 U2 - PMID: 18211652. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105885074&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105866149 T1 - Regret associated with the decision for breast reconstruction: the association of negative body image, distress and surgery characteristics with decision regret. AU - Sheehan J AU - Sherman KA AU - Lam T AU - Boyages J Y1 - 2008/02// N1 - Accession Number: 105866149. Language: English. Entry Date: 20080321. Revision Date: 20150819. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Double Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. Special Interest: Oncologic Care; Psychiatry/Psychology; Women's Health. Instrumentation: Positive and Negative Affect Schedule (PANAS) (Watson et al); 6-item Social Support Questionnaire (SSQ-6) (Sarason et al); Body Image Scale (BIS) (Hopwood et al); Decision Regret Scale (Brehaut et al); Impact of Events Scale (IES). NLM UID: 8807983. KW - Body Image KW - Breast Neoplasms -- Psychosocial Factors KW - Breast Reconstruction -- Psychosocial Factors KW - Decision Making KW - Emotions KW - Stress, Psychological KW - Adult KW - Aged KW - Aged, 80 and Over KW - Australia KW - Bivariate Statistics KW - Chi Square Test KW - Coefficient Alpha KW - Correlation Coefficient KW - Cross Sectional Studies KW - Data Analysis Software KW - Descriptive Statistics KW - Female KW - Impact of Events Scale KW - Logistic Regression KW - Middle Age KW - Pearson's Correlation Coefficient KW - Psychological Tests KW - Questionnaires KW - Spearman's Rank Correlation Coefficient KW - Summated Rating Scaling KW - Human SP - 207 EP - 219 JO - Psychology & Health JF - Psychology & Health JA - PSYCHOL HEALTH VL - 23 IS - 2 CY - Oxfordshire, PB - Routledge AB - This study investigated the influence of psychosocial and surgical factors on decision regret among 123 women diagnosed with breast cancer who had undergone immediate (58%) or delayed (42%) breast reconstruction following mastectomy. The majority of participants (52.8%, n = 65) experienced no decision regret, 27.6% experienced mild regret and 19.5% moderate to strong regret. Bivariate analyses indicated that decision regret was associated with negative body image and psychological distress - intrusion and avoidance. There were no differences in decision regret either with respect to methods or timing patterns of reconstructive surgery. Multinominal logistic regression analysis showed that, when controlling for mood state and time since last reconstructive procedure, increases in negative body image were associated with increased likelihood of experiencing decision regret. These findings highlight the need for optimal input from surgeons and therapists in order to promote realistic expectations regarding the outcome of breast reconstruction and to reduce the likelihood of women experiencing decision regret. SN - 0887-0446 AD - Department of Psychology, Macquarie University, Australia UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105866149&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105358625 T1 - How does age affect baseline screening mammography performance measures? A decision model. AU - Keen JD AU - Keen JE AU - Keen, John D AU - Keen, James E Y1 - 2008/01// N1 - Accession Number: 105358625. Language: English. Entry Date: 20090626. Revision Date: 20170405. Publication Type: journal article; research. Journal Subset: Biomedical; Computer/Information Science; Europe; UK & Ireland. Special Interest: Informatics. NLM UID: 101088682. KW - Breast Neoplasms -- Radiography KW - Decision Trees KW - Mammography -- Standards KW - Outcome Assessment -- Methods KW - Adult KW - Age Factors KW - Aged KW - Breast Neoplasms -- Epidemiology KW - Female KW - Health Screening -- Standards KW - Middle Age KW - Predictive Value of Tests KW - Prevalence KW - Sensitivity and Specificity KW - Human SP - 40 EP - 40 JO - BMC Medical Informatics & Decision Making JF - BMC Medical Informatics & Decision Making JA - BMC MED INFORM DECIS MAKING VL - 8 IS - 1 PB - BioMed Central AB - Background: In order to promote consumer-oriented informed medical decision-making regarding screening mammography, we created a decision model to predict the age dependence of the cancer detection rate, the recall rate and the secondary performance measures (positive predictive values, total intervention rate, and positive biopsy fraction) for a baseline mammogram. Methods: We constructed a decision tree to model the possible outcomes of a baseline screening mammogram in women ages 35 to 65. We compared the single baseline screening mammogram decision with the no screening alternative. We used the Surveillance Epidemiology and End Results national cancer database as the primary input to estimate cancer prevalence. For other probabilities, the model used population-based estimates for screening mammography accuracy and diagnostic mammography outcomes specific to baseline exams. We varied radiologist performance for screening accuracy. Results: The cancer detection rate increases from 1.9/1000 at age 40 to 7.2/1000 at age 50 to 15.1/1000 at age 60. The recall rate remains relatively stable at 142-157/1000, which varies from 73-236/1000 at age 50 depending on radiologist performance. The positive predictive value of a screening mammogram increases from 1.3% at age 40 to 9.8% at age 60, while the positive predictive value of a diagnostic mammogram varies from 2.9% at age 40 to 19.2% at age 60. The model predicts the total intervention rate = 0.013*AGE2 - 0.67*AGE + 40, or 34/1000 at age 40 to 47/1000 at age 60. Therefore, the positive biopsy (intervention) fraction varies from 6% at age 40 to 32% at age 60. Conclusion: Breast cancer prevalence, the cancer detection rate, and all secondary screening mammography performance measures increase substantially with age. SN - 1472-6947 AD - Department of Radiology, John H. Stroger Jr. Hospital of Cook County, 1901 West Harrison Street, Chicago, IL 60612-9985, USA AD - Department of Radiology, John H. Stroger Jr. Hospital of Cook County, 1901 West Harrison Street, Chicago, IL 60612-9985, USA. jkeen@ccbhs.org U2 - PMID: 18803871. DO - 10.1186/1472-6947-8-40 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105358625&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105358604 T1 - Non-compliance with a postmastectomy radiotherapy guideline: decision tree and cause analysis. AU - Razavi AR AU - Gill H AU - Ahlfeldt H AU - Shahsavar N Y1 - 2008/01// N1 - Accession Number: 105358604. Language: English. Entry Date: 20090626. Revision Date: 20171129. Publication Type: Journal Article; case study; research. Journal Subset: Biomedical; Computer/Information Science; Europe; UK & Ireland. Special Interest: Informatics. NLM UID: 101088682. KW - Breast Neoplasms -- Radiotherapy KW - Decision Trees KW - Guideline Adherence -- Statistics and Numerical Data KW - Radiotherapy, Adjuvant -- Utilization KW - Treatment Refusal -- Statistics and Numerical Data KW - Age Factors KW - Breast Neoplasms -- Surgery KW - Data Collection KW - Female KW - Mastectomy KW - Neoplasm Recurrence, Local -- Prevention and Control KW - Practice Guidelines KW - Sweden KW - Human SP - 41 EP - 41 JO - BMC Medical Informatics & Decision Making JF - BMC Medical Informatics & Decision Making JA - BMC MED INFORM DECIS MAKING VL - 8 IS - 1 PB - BioMed Central AB - Background: The guideline for postmastectomy radiotherapy (PMRT), which is prescribed to reduce recurrence of breast cancer in the chest wall and improve overall survival, is not always followed. Identifying and extracting important patterns of non-compliance are crucial in maintaining the quality of care in Oncology. Methods: Analysis of 759 patients with malignant breast cancer using decision tree induction (DTI) found patterns of non-compliance with the guideline. The PMRT guideline was used to separate cases according to the recommendation to receive or not receive PMRT. The two groups of patients were analyzed separately. Resulting patterns were transformed into rules that were then compared with the reasons that were extracted by manual inspection of records for the noncompliant cases. Results: Analyzing patients in the group who should receive PMRT according to the guideline did not result in a robust decision tree. However, classification of the other group, patients who should not receive PMRT treatment according to the guideline, resulted in a tree with nine leaves and three of them were representing non-compliance with the guideline. In a comparison between rules resulting from these three non-compliant patterns and manual inspection of patient records, the following was found: In the decision tree, presence of perigland growth is the most important variable followed by number of malignantly invaded lymph nodes and level of Progesterone receptor. DNA index, age, size of the tumor and level of Estrogen receptor are also involved but with less importance. From manual inspection of the cases, the most frequent pattern for non-compliance is age above the threshold followed by near cut-off values for risk factors and unknown reasons. Conclusion: Comparison of patterns of non-compliance acquired from data mining and manual inspection of patient records demonstrates that not all of the non-compliances are repetitive or important. There are some overlaps between important variables acquired from manual inspection of patient records and data mining but they are not identical. Data mining can highlight noncompliance patterns valuable for guideline authors and for medical audit. Improving guidelines by using feedback from data mining can improve the quality of care in oncology. SN - 1472-6947 AD - Department of Biomedical Engineering, Division of Medical Informatics, Linköping University, Sweden. amira@imt.liu.se U2 - PMID: 18803875. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105358604&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - THES ID - 109849934 T1 - Cognitive appraisal, coping behaviors, and decisional outcomes in women making a treatment decision for their increased risk of breast cancer. AU - Wood JM Y1 - 2008/01// N1 - Accession Number: 109849934. Language: English. Entry Date: 20081031. Revision Date: 20150923. Publication Type: Doctoral Dissertation; research. Special Interest: Psychiatry/Psychology; Women's Health. Instrumentation: Impact of Events Scale (IES); Decisional Conflict Scale (O'Connor); Ways of Coping Questionnaire (WCQ) (Folkman et al) [revised]. KW - Breast Neoplasms KW - Coping KW - Decision Making, Patient KW - Risk Assessment KW - Stress, Psychological KW - Women -- Psychosocial Factors KW - Adult KW - Aged KW - Correlational Studies KW - Cross Sectional Studies KW - Descriptive Research KW - Female KW - Impact of Events Scale KW - Middle Age KW - Scales KW - Self Report KW - Ways of Coping Questionnaire KW - Human SP - 164 p EP - 164 p JO - Cognitive Appraisal, Coping Behaviors & Decisional Outcomes in Women Making a Treatment Decision for Their Increased Risk of Breast Cancer JF - Cognitive Appraisal, Coping Behaviors & Decisional Outcomes in Women Making a Treatment Decision for Their Increased Risk of Breast Cancer PB - Kent State University AB - This cross-sectional descriptive correlational study was conducted to examine the relationships between and among the threat of breast cancer (objective and subjective risk), subjective stress, decisional conflict (uncertainty and factors associated with uncertainty), type of coping (approach and avoidance coping behaviors), and decisional outcome (treatment choice and decision effectiveness) in women making a treatment choice for their increased risk of developing breast cancer.The sample consisted of 105 women who came to a high risk breast cancer clinic for a breast cancer risk assessment. Participants' ages ranged from 35-72. The majority of the women were married, Caucasian, highly educated, and employed fulltime. A booklet with four self-report questionnaires was used for data collection including a sociodemographic questionnaire developed by the researcher, Horowitz's Impact of Event Scale, O'Connor's Decisional Conflict Scale, and Lazarus and Folkman's Ways of Coping Revised Questionnaire.Each hypothesis in the study was at least partially supported. Subjective stress and decision uncertainty were significant predictors for using approach coping behavior, but only subjective stress significantly predicted the use of avoidance coping behavior. The variance in treatment choice was significantly explained by subjective 5-year risk, factors associated with decision uncertainty, and objective risk, while the variance in decision effectiveness was significantly explained by decision uncertainty and factors associated with decision uncertainty. Lastly, approach coping behavior explained a small but significant amount of the variance in decision effectiveness.Women at risk for developing breast cancer used approach and avoidance coping behaviors to manage the stress associated with their increased risk for breast cancer and consideration of treatment options. Women who used approach coping felt more certain about their treatment choice. Avoidance coping tended to be used by women who were uncertain about their treatment choice with a marginally significant positive relationship between avoidance coping and decision uncertainty. Women who were knowledgeable and clear about their values related to treatment options were more apt to select chemoprevention or prophylactic mastectomy, when appropriate, and felt they made an effective decision. SN - 9780549477754 AV - UMI Order AAI3302247 M1 - Ph.D. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109849934&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105829240 T1 - Information acquisition for women facing surgical treatment for breast cancer: Influencing factors and selected outcomes. AU - O'Leary KA AU - Estabrooks CA AU - Olson K AU - Cumming C Y1 - 2007/12// N1 - Accession Number: 105829240. Language: English. Entry Date: 20080307. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Core Nursing; Europe; Health Promotion/Education; Nursing; Peer Reviewed; UK & Ireland. NLM UID: 8406280. KW - Attitude to Health KW - Breast Neoplasms -- Psychosocial Factors KW - Breast Neoplasms -- Surgery KW - Mastectomy -- Education KW - Mastectomy -- Methods KW - Mastectomy -- Psychosocial Factors KW - Patient Education KW - Women -- Education KW - Women -- Psychosocial Factors KW - Consumer Participation -- Psychosocial Factors KW - Decision Making KW - Decision Support Techniques KW - Female KW - Health Services Needs and Demand KW - Locus of Control KW - Models, Educational KW - Models, Psychological KW - Patient Selection KW - Power KW - Study Design KW - Support, Psychosocial KW - Human SP - 5 EP - 19 JO - Patient Education & Counseling JF - Patient Education & Counseling JA - PATIENT EDUC COUNS VL - 69 IS - 1-3 PB - Elsevier B.V. AB - OBJECTIVE: To examine, summarize, and critically assess the literature focusing on information use by early-stage breast cancer patients. METHODS: Empirical articles reporting the information needs, sources used/preferred, and intervention-related outcomes experienced by patients in the context of making a treatment choice were chosen. Several healthcare databases were searched. Articles were limited to those published in English between January 1, 1986 and March 31, 2006. RESULTS: A total of 25 articles met the inclusion criteria. Information needs were consistent, and highest rankings were for (in order): information about chances for a cure, stage of disease, and treatment options. Results were equivocal regarding the factors found to influence information need: age, time since diagnosis, and preferred role in decision-making. The highest ranked information sources accessed and preferred were physicians. Age, education, and type of treatment chosen influenced source choice. Patients using consumer decision aids (CDAs) had less decisional conflict, higher satisfaction with the decision made and the decision process, and higher knowledge levels. CONCLUSION: Information needs and source use were influenced by several personal and contextual factors. PRACTICE IMPLICATIONS: A better understanding of source use could provide more effective ways of disseminating information to patients. SN - 0738-3991 AD - Knowledge Utilization Studies Program, University of Alberta, Canada; Faculty of Nursing, University of Alberta, Canada. U2 - PMID: 17889495. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105829240&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105829254 T1 - "If I'm better than average, then I'm ok?": Comparative information influences beliefs about risk and benefits. AU - Fagerlin A AU - Zikmund-Fisher BJ AU - Ubel PA AU - Fagerlin, Angela AU - Zikmund-Fisher, Brian J AU - Ubel, Peter A Y1 - 2007/12// N1 - Accession Number: 105829254. Language: English. Entry Date: 20080307. Revision Date: 20161125. Publication Type: journal article; clinical trial; research. Journal Subset: Core Nursing; Europe; Health Promotion/Education; Nursing; Peer Reviewed; UK & Ireland. Grant Information: R01 CA87595/CA/NCI NIH HHS/United States. NLM UID: 8406280. KW - Attitude to Health KW - Breast Neoplasms -- Prevention and Control KW - Health Education -- Methods KW - Risk Assessment -- Methods KW - Women -- Education KW - Women -- Psychosocial Factors KW - Adult KW - Aged KW - Aged, 80 and Over KW - Analysis of Variance KW - Behavior KW - Breast Neoplasms -- Etiology KW - Chi Square Test KW - Clinical Trials KW - Communication KW - Decision Making KW - Decision Support Techniques KW - Drug Therapy -- Adverse Effects KW - Drug Therapy -- Psychosocial Factors KW - Health Behavior KW - Health Services Needs and Demand KW - Middle Age KW - Questionnaires KW - Women's Health KW - Human SP - 140 EP - 144 JO - Patient Education & Counseling JF - Patient Education & Counseling JA - PATIENT EDUC COUNS VL - 69 IS - 1-3 PB - Elsevier B.V. AB - Objective: To test whether providing comparative risk information changes risk perceptions.Methods: Two hundred and forty-nine female visitors to a hospital cafeteria were randomized to one of two conditions which differed in whether their hypothetical breast cancer risks was lower or higher than the average women's. Participants read a scenario describing a breast cancer prevention pill and indicated their: (1) likelihood of taking the pill and (2) perception of whether the pill provides breast cancer risk reduction.Results: Women told that their hypothetical risk of breast cancer was above average were more likely to endorse taking the pill (2.79 vs. 2.23, F=4.95, p=0.002) and more likely to believe that the pill provided a significant risk reduction in breast cancer (3.15 vs. 2.73, F=4.32, p=0.005), even though the risks were equivalent.Conclusions: Providing people with comparative risk information changes their risk perceptions. People who have above average risk may feel compelled to take a treatment because they are at above average risk and therefore may not thoroughly consider the trade-offs in the risks and benefits of treatment.Practice Implications: Physicians and decision aid developers must reconsider the practice of communicating "average risk" information to patients. SN - 0738-3991 AD - VA Health Services Research & Development Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States AD - Division of General Medicine, University of Michigan, 300 North Ingalls Building, RM 7C27, Ann Arbor, MI 48109-0429, United States; fagerlin@umich.edu U2 - PMID: 17942271. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105829254&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105818555 T1 - A decision tool for predicting sentinel node accuracy from breast tumor size and grade. AU - Coombs N AU - Chen W AU - Taylor R AU - Boyages J Y1 - 2007/11//Nov/Dec2007 N1 - Accession Number: 105818555. Language: English. Entry Date: 20090102. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Peer Reviewed; USA. NLM UID: 9505539. KW - Breast Neoplasms -- Epidemiology KW - Breast Neoplasms -- Pathology KW - Carcinoma -- Pathology KW - Carcinoma KW - Lymph Nodes -- Pathology KW - Sentinel Lymph Node Biopsy -- Statistics and Numerical Data KW - Adult KW - Aged KW - Aged, 80 and Over KW - Chi Square Test KW - Data Analysis, Statistical KW - Decision Support Techniques KW - False Negative Results KW - Female KW - Middle Age KW - Neoplasm Metastasis -- Diagnosis KW - Neoplasm Staging KW - New South Wales KW - Predictive Value of Tests KW - Human SP - 593 EP - 598 JO - Breast Journal JF - Breast Journal JA - BREAST J VL - 13 IS - 6 CY - Malden, Massachusetts PB - Wiley-Blackwell AB - The ability to predict axillary lymph node involvement in breast cancer patients in the preoperative setting is invaluable. This study provides a simple set of formulae to enable clinicians to make informed decisions in the management of screen-detected breast cancer. The tumor pathology reports were obtained of all 4,585 women identified between 1996 and 1999 in New South Wales (NSW) with T1 or T2 breast cancer by the statewide co-ordinated breast screening service (BreastScreen NSW). Equations predicting node positivity were calculated by linear regression analysis and, from published sentinel node false-negative rates, the probability of retrieval of a false-negative axillary lymph node by sentinel node biopsy was calculated for tumors of different size and grade. Node involvement was identified in 1,089 (23.8%) of women. A linear relationship for tumor size, grade, and nodal involvement was predicted by: frequency (%) = 1.5 x tumor size (mm) + 2 (or 6 or 10) for grade I (or II or III) tumors. Assuming a 7.5% false-negative rate, the probability of retrieving a false-negative sentinel node ranged from 0.8% for a patient with a 5 mm, grade I carcinoma to 6.0% for a 50 mm, grade III tumor. These simple formulae are easy to use in a clinical setting. The reference table enables breast surgeons to inform a patient about the absolute probability of false-negative sentinel biopsy rates for patients with screen-detected carcinomas when size can be estimated from preoperative imaging and when tumor grade is often available from preoperative core biopsy. Patients with large, T2 breast tumors may be best treated with axillary dissection rather than sentinel node biopsy alone due to the risk of under-staging the woman's disease and also the high probability of finding a positive sentinel node. SN - 1075-122X AD - NSW Breast Cancer Institute, Westmead Hospital, Westmead, New South Wales, Australia. U2 - PMID: 17983402. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105818555&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105988427 T1 - Putting shared decision making to work in breast and prostate cancers: tools for community oncologists. AU - Sepucha KR AU - Belkora J Y1 - 2007/11//2007 Nov N1 - Accession Number: 105988427. Language: English. Entry Date: 20080222. Revision Date: 20150711. Publication Type: Journal Article; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 101223547. KW - Breast Neoplasms KW - Community Health Centers KW - Patient Autonomy KW - Prostatic Neoplasms KW - Female KW - Male KW - Patient Education KW - Physician-Patient Relations SP - 685 EP - [691] JO - Community Oncology JF - Community Oncology JA - COMMUNITY ONCOL VL - 4 IS - 11 PB - Elsevier B.V. AB - A diagnosis of prostate or breast cancer throws patients into a state of cognitive and emotional overload. Patient anxiety and confusion can be exacerbated when there is no single dominant treatment, but rather multiple treatment options that require patients and oncologists to make trade-offs between benefits and harms. Patients rely on their oncologists to guide them to good decisions. There are an increasing number of tools available to help oncologists engage and educate their patients before, during, and after consultations. We discuss four tools that are available to community oncology practices: decision aids; prompt sheets; knowledge and preference surveys; and structured consultation notes. Community oncologists may wish to adapt and implement these tools in their practices to help their patients make informed choices. SN - 1548-5315 AD - Senior Scientist, Health Decision Research Unit, Massachusetts General Hospital, 50 Stanford Street, Suite 936, Boston, MA 02114; ksepucha@partners.org UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105988427&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105945533 T1 - Decision aids in clinical trials can enhance informed consent: tools help match decisions to subjects' values. Y1 - 2007/11// N1 - Accession Number: 105945533. Language: English. Entry Date: 20080125. Revision Date: 20150711. Publication Type: Journal Article. Journal Subset: Biomedical; USA. NLM UID: 101133476. KW - Clinical Trials KW - Consent KW - Decision Making -- Methods KW - Breast Neoplasms KW - Institutional Review KW - Readability SP - 129 EP - 132 JO - IRB Advisor JF - IRB Advisor JA - IRB ADVIS VL - 7 IS - 11 CY - Atlanta, Georgia PB - AHC Media LLC SN - 1535-2064 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105945533&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105817651 T1 - Informed choice in mammography screening: a randomized trial of a decision aid for 70-year-old women. AU - Mathieu E AU - Barratt A AU - Davey HM AU - McGeechan K AU - Howard K AU - Houssami N Y1 - 2007/10/22/ N1 - Accession Number: 105817651. Language: English. Entry Date: 20080307. Revision Date: 20150711. Publication Type: Journal Article; clinical trial; research. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 0372440. KW - Breast Neoplasms -- Radiography KW - Decision Support Techniques KW - Mammography -- Utilization KW - Aged KW - Attitude to Health KW - Clinical Trials KW - Consumer Participation KW - Decision Making KW - Female KW - Mammography -- Statistics and Numerical Data KW - New South Wales KW - Outcome Assessment KW - Patient Education KW - Patient Satisfaction KW - Human SP - 2039 EP - 2046 JO - Archives of Internal Medicine JF - Archives of Internal Medicine JA - ARCH INTERN MED VL - 167 IS - 19 CY - Chicago, Illinois PB - American Medical Association SN - 0003-9926 AD - Screening and Test Evaluation Program, School of Public Health, University of Sydney, Sydney, Australia. U2 - PMID: 17954796. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105817651&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106181011 T1 - Re: 'Pilot trial of a computerized decision aid for breast cancer prevention'...Ozanne EM, Annis Co, Adduci K, Showstack J, Esserman L. Pilot trial of a computerized decision aid for breast cancer prevention. Breast J 2007; 13:147-54 AU - Cady B AU - Chung MA Y1 - 2007/09//Sep/Oct2007 N1 - Accession Number: 106181011. Language: English. Entry Date: 20090710. Revision Date: 20150711. Publication Type: Journal Article; commentary; letter. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Peer Reviewed; USA. NLM UID: 9505539. KW - Breast Neoplasms -- Prevention and Control KW - Female SP - 539 EP - 540 JO - Breast Journal JF - Breast Journal JA - BREAST J VL - 13 IS - 5 CY - Malden, Massachusetts PB - Wiley-Blackwell SN - 1075-122X U2 - PMID: 17760687. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106181011&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105366338 T1 - Response...Re: 'Pilot trial of a computerized decision aid for breast cancer prevention' AU - Ozanne EM AU - Hwang ES AU - Esserman LJ Y1 - 2007/09//Sep/Oct2007 N1 - Accession Number: 105366338. Language: English. Entry Date: 20090710. Revision Date: 20150711. Publication Type: Journal Article; response. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Peer Reviewed; USA. NLM UID: 9505539. KW - Biological Markers KW - Breast Neoplasms KW - Female KW - Neoplasm Invasiveness -- Prevention and Control SP - 540 EP - 542 JO - Breast Journal JF - Breast Journal JA - BREAST J VL - 13 IS - 5 CY - Malden, Massachusetts PB - Wiley-Blackwell SN - 1075-122X UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105366338&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105792384 T1 - Breast cancer risk reduction. AU - Bevers TB AU - Armstrong DK AU - Arun B AU - Carlson RW AU - Cowan KH AU - Daly MB AU - Fleming I AU - Garber JE AU - Gemignani M AU - Gradishar WJ AU - Krontiras H AU - Kulkarni S AU - Laronga C AU - Lawton T AU - Loftus L AU - Macdonald DJ AU - Mahoney MC AU - Merajver SD AU - Seewaldt V AU - Sellin RV Y1 - 2007/09//2007 Sep N1 - Accession Number: 105792384. Language: English. Entry Date: 20080822. Revision Date: 20150711. Publication Type: Journal Article; practice guidelines. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 101162515. KW - Breast Neoplasms -- Prevention and Control KW - Health Promotion KW - Decision Trees KW - Female SP - 676 EP - 701 JO - Journal of the National Comprehensive Cancer Network JF - Journal of the National Comprehensive Cancer Network JA - J NATL COMPR CANCER NETW JNCCN VL - 5 IS - 8 CY - Cold Spring Harbor, New York PB - Harborside Press SN - 1540-1405 U2 - PMID: 17927926. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105792384&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105830746 T1 - Why older adults make more immediate treatment decisions about cancer than younger adults. AU - Meyer BJ AU - Talbot AP AU - Ranalli C Y1 - 2007/09// N1 - Accession Number: 105830746. Language: English. Entry Date: 20080307. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Peer Reviewed; USA. NLM UID: 8904079. KW - Breast Neoplasms -- Psychosocial Factors KW - Decision Making KW - Prostatic Neoplasms -- Psychosocial Factors KW - Adolescence KW - Adult KW - Age Factors KW - Aged KW - Aged, 80 and Over KW - Attitude to Health KW - Biopsy -- Psychosocial Factors KW - Brachytherapy -- Psychosocial Factors KW - Breast Neoplasms -- Diagnosis KW - Breast Neoplasms -- Therapy KW - Consumer Participation KW - Decision Trees KW - Female KW - Lumpectomy -- Psychosocial Factors KW - Male KW - Middle Age KW - Ohio KW - Patient Education KW - Pennsylvania KW - Problem Solving KW - Prostatectomy -- Psychosocial Factors KW - Prostatic Neoplasms -- Diagnosis KW - Prostatic Neoplasms -- Therapy KW - Sex Factors KW - Surveys KW - Human SP - 505 EP - 524 JO - Psychology & Aging JF - Psychology & Aging JA - PSYCHOL AGING VL - 22 IS - 3 CY - Washington, District of Columbia PB - American Psychological Association AB - Literature relevant to medical decision making was reviewed, and a model was outlined for testing. Two studies examined whether older adults make more immediate decisions than younger adults about treatments for prostate or breast cancer in authentic scenarios. Findings clearly showed that older adults were more likely to make immediate decisions than younger adults. The research is important because it not only demonstrates the consistency of this age-related effect across disease domains, gender, ethnic groups, and prevalent education levels but begins to investigate a model to explain the effect. Major reasons for the effect focus on treatment knowledge, interest and engagement, and cognitive resources. Treatment knowledge, general cancer knowledge, interest, and cognitive resources relate to different ways of processing treatment information and preferences for immediate versus delayed decision making. Adults with high knowledge of treatments on a reliable test tended to make immediate treatment decisions, which supports the knowledge explanation. Adults with more cognitive resources and more interest tended to delay their treatment decisions. Little support was found for a cohort explanation for the relationship between age and preference for immediate medical decision making. (PsycINFO Database Record (c) 2007 APA, all rights reserved). SN - 0882-7974 AD - Department of Educational and School Psychology and Special Education. U2 - PMID: 17874951. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105830746&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106173912 T1 - The role of cognitive appraisal and worry in BRCA1/2 testing decisions among a clinic population. AU - Wang C AU - Gonzalez R AU - Janz NK AU - Milliron KJ AU - Merajver SD Y1 - 2007/08// N1 - Accession Number: 106173912. Language: English. Entry Date: 20071019. Revision Date: 20150819. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Double Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. Grant Information: Supported in part by the Canadian Institutes of Health Research (CIHR) and the American Association of University Women Educational Foundation (AAUW), and also by the Susan G. Komen Breast Cancer Foundation, the University of Michigan Comprehensive Cancer Center, and the Venture Investment Fund of the University of Michigan Health System. NLM UID: 8807983. KW - Breast Neoplasms -- Familial and Genetic KW - Decision Making, Patient KW - Genetic Screening -- Psychosocial Factors KW - Stress, Psychological KW - Bivariate Statistics KW - Chi Square Test KW - Coefficient Alpha KW - Confidence Intervals KW - Descriptive Statistics KW - Experimental Studies KW - Female KW - Funding Source KW - Genetic Counseling KW - Health Belief Model KW - Logistic Regression KW - Michigan KW - Multivariate Analysis KW - Odds Ratio KW - Pearson's Correlation Coefficient KW - Questionnaires KW - Record Review KW - Scales KW - Summated Rating Scaling KW - Human SP - 719 EP - 736 JO - Psychology & Health JF - Psychology & Health JA - PSYCHOL HEALTH VL - 22 IS - 6 CY - Oxfordshire, PB - Routledge AB - Previous studies examining decision making in the context of genetic testing for BRCA1/2 gene mutations have been limited in their reliance on cross-sectional designs, lack of theoretical guidance, and focus on measures of intention rather than actual behavior. Informed by the Health Belief Model and other theories of self-regulation, the present study set out to examine the role of cognitive appraisal and worry in BRCA1/2 testing decisions. A total of 205 women completed baseline questionnaires prior to their genetic counselling appointment. Medical charts were audited to determine testing decisions. Bivariate analyses indicated that perceived severity of being a carrier and perceived benefits and barriers to testing were significantly associated with testing decisions. Perceived benefits remained significant in multivariate analyses. Moreover, multivariate analyses revealed a significant three-way interaction between perceived susceptibility, perceived severity, and worry about being a mutation carrier and testing decisions. Among women high in baseline worry, those high in perceived susceptibility but low in perceived severity were significantly more likely to undergo genetic testing than all other susceptibility/severity combinations (80% vs. 36.2-42.9% range; Wald test = 8.79, p < 0.01). These results support the need for researchers and practitioners to consider how interactions between cognition and worry may influence genetic testing decisions. SN - 0887-0446 AD - Division of Population Science, Fox Chase Cancer Center, Philadelphia, PA. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106173912&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105982912 T1 - Clinical response by palpation during primary systemic therapy with four dose-dense cycles doxorubicin and docetaxel in patients with operable breast cancer: further results from a randomised controlled trial. AU - Müller C AU - Caputo A AU - Schumacher M AU - Raab G AU - Schütte M AU - Hilfrich J AU - Kaufmann M AU - von Minckwitz G Y1 - 2007/07/15/ N1 - Accession Number: 105982912. Language: English. Entry Date: 20080215. Revision Date: 20150711. Publication Type: Journal Article; research; randomized controlled trial. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. NLM UID: 9005373. KW - Antineoplastic Agents, Combined -- Therapeutic Use KW - Breast Neoplasms -- Drug Therapy KW - Palpation KW - Adult KW - Aged KW - Randomized Controlled Trials KW - Doxorubicin -- Administration and Dosage KW - Female KW - Hydrocarbons -- Administration and Dosage KW - Middle Age KW - Treatment Outcomes KW - Human SP - 1654 EP - 1661 JO - European Journal of Cancer JF - European Journal of Cancer JA - EUR J CANCER VL - 43 IS - 11 PB - Pergamon Press - An Imprint of Elsevier Science AB - Primary systemic therapy (PST) allows the observation of tumour response under treatment, but little is known regarding the typical course of clinical response during such therapy. The aim of this study is to support decision making in case of insufficient clinical response. Tumour response was assessed by palpation at different times in 436 patients with operable breast cancer from the dose-dense biweekly therapy arm of the GEPARDUO phase III trial. The predictive value of clinical response for pathologic complete response (pCR), prognostic models to assess the prognosis and individual courses of clinical response were investigated. Sensitivity and positive predictive value were low, but comparatively highest after the 3rd cycle. The predictive value of clinical response by palpation for pCR was subsequently limited. The majority of patients (68.1%) experienced a consistent decrease in tumour size during PST. The results indicate that decisions about further treatment should take place at the earliest after the 3rd cycle or 6 weeks of dose-dense PST. SN - 0959-8049 AD - Center of Clinical Trials, University Medical Center Freiburg, Elsaesser Strasse 2, 79110 Freiburg, Germany. christine.mueller@uniklinik-freiburg.de U2 - PMID: 17544652. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105982912&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105899865 T1 - Oncotype DX recurrence score influences treatment decisions. Y1 - 2007/07// N1 - Accession Number: 105899865. Language: English. Entry Date: 20080425. Revision Date: 20150711. Publication Type: Journal Article; brief item. Journal Subset: Biomedical; USA. NLM UID: 9214988. KW - Breast Neoplasms -- Therapy KW - Decision Making, Clinical KW - Decision Support Techniques KW - Chemotherapy, Adjuvant SP - 22 EP - 22 JO - Oncology News International JF - Oncology News International JA - ONCOL NEWS INT VL - 16 IS - 7 CY - Norwalk, Connecticut PB - UBM Medica SN - 1065-2957 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105899865&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106136672 T1 - Development and pilot testing of two decision aids for individuals considering genetic testing for cancer risk. AU - Wakefield CE AU - Meiser B AU - Homewood J AU - Peate M AU - Kirk J AU - Warner B AU - Lobb E AU - Gaff C AU - Tucker K Y1 - 2007/06/06/ N1 - Accession Number: 106136672. Language: English. Entry Date: 20070817. Revision Date: 20170831. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Continental Europe; Europe; Peer Reviewed. Grant Information: Cancer Council of New South Wales (Project Grant 300441); Australian Postgraduate Award from Macquarie University; Career Development Award from the National Health and Medical Research Council of Australia (ID 350989). NLM UID: 9206865. KW - Breast Neoplasms -- Familial and Genetic KW - Decision Making KW - Genetic Screening -- Psychosocial Factors KW - Adult KW - Analysis of Variance KW - Chi Square Test KW - Conceptual Framework KW - Data Analysis Software KW - Data Analysis, Statistical KW - Descriptive Statistics KW - Female KW - Fisher's Exact Test KW - Funding Source KW - Kruskal-Wallis Test KW - Mann-Whitney U Test KW - P-Value KW - Patient Satisfaction KW - Questionnaires KW - Readability KW - Self Report KW - T-Tests KW - Human SP - 325 EP - 339 JO - Journal of Genetic Counseling JF - Journal of Genetic Counseling JA - J GENETIC COUNS VL - 16 IS - 3 CY - , PB - Springer Science & Business Media B.V. SN - 1059-7700 AD - Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW 2031, Sydney, Australia; c.wakefield@unsw.edu.au U2 - PMID: 17318456. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106136672&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105978753 T1 - Perceived helpfulness and impact of social support provided by family, friends, and health care providers to women newly diagnosed with breast cancer. AU - Arora NK AU - Finney Rutten LJ AU - Gustafson DH AU - Moser R AU - Hawkins RP Y1 - 2007/05// N1 - Accession Number: 105978753. Language: English. Entry Date: 20080215. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. Instrumentation: Health-Related Quality of Life (HRQOL). NLM UID: 9214524. KW - Breast Neoplasms -- Psychosocial Factors KW - Family -- Psychosocial Factors KW - Friendship KW - Physician's Role KW - Sick Role KW - Support, Psychosocial KW - Adaptation, Psychological KW - Adult KW - Breast Neoplasms -- Diagnosis KW - Decision Making KW - Female KW - Middle Age KW - Patient Education KW - Patient Satisfaction KW - Prospective Studies KW - Quality of Life -- Psychosocial Factors KW - Questionnaires KW - Self-Efficacy KW - Support Groups KW - Human SP - 474 EP - 486 JO - Psycho-Oncology JF - Psycho-Oncology JA - PSYCHO ONCOL VL - 16 IS - 5 CY - Hoboken, New Jersey PB - John Wiley & Sons, Inc. AB - We evaluated the helpfulness of informational, emotional, and decision-making support received by women newly diagnosed with breast cancer from their family, friends, and health care providers. Data were collected at two time points via patient surveys: baseline on an average 2 months post-diagnosis and follow-up at 5 months post-baseline. In the period closer to diagnosis, majority of the women received helpful informational support from health care providers (84.0%); helpful emotional support from family (85%), friends (80.4%), and providers (67.1%); and helpful decision-making support from providers (75.2%) and family (71.0%). Emotional support at baseline and emotional and informational support at 5-month follow-up were significantly associated with patients' health-related quality of life and self-efficacy outcomes (p<0.01). Perceived helpfulness of informational, emotional, and decision-making support provided by family, friends, and providers however significantly decreased over time (p<0.001). Cancer patients' desire significant amount of support throughout their cancer journey. Our results show that while patients receive a lot of support during the period closer to diagnosis, receipt of helpful support drops significantly within the first year itself. In order to facilitate cancer patients' adjustment to their illness, efforts need to be made to understand and address their support needs throughout the cancer experience. Copyright (c) 2006 John Wiley & Sons, Ltd. SN - 1057-9249 U2 - PMID: 16986172. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105978753&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105950490 T1 - Improving informed consent in clinical trials: successful piloting of a decision aid...J Clin Oncol. 2006 Sep 1;24(25):4158-62 AU - Juraskova I AU - Butow P AU - Lopez AL AU - Seccombe M AU - Boyle F AU - McCarthy N AU - Forbes JF Y1 - 2007/04/10/ N1 - Accession Number: 105950490. Language: English. Entry Date: 20080201. Revision Date: 20150711. Publication Type: Journal Article; commentary; letter; response. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 8309333. KW - Brachytherapy KW - Breast Neoplasms -- Prevention and Control KW - Clinical Trials KW - Consent KW - Decision Making KW - Patient Education -- Methods KW - Patient Selection KW - Prostatectomy KW - Prostatic Neoplasms -- Therapy KW - Aged KW - Female KW - Male KW - Middle Age KW - Ontario KW - Prostatic Neoplasms -- Radiotherapy KW - Prostatic Neoplasms -- Surgery KW - Questionnaires SP - 1443 EP - 1444 JO - Journal of Clinical Oncology JF - Journal of Clinical Oncology JA - J CLIN ONCOL VL - 25 IS - 11 CY - Alexandria, Virginia PB - American Society of Clinical Oncology SN - 0732-183X U2 - PMID: 17416867. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105950490&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105978740 T1 - Association of information satisfaction, psychological distress and monitoring coping style with post-decision regret following breast reconstruction. AU - Sheehan J AU - Sherman KA AU - Lam T AU - Boyages J Y1 - 2007/04// N1 - Accession Number: 105978740. Language: English. Entry Date: 20080215. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. NLM UID: 9214524. KW - Adaptation, Psychological KW - Breast Neoplasms -- Surgery KW - Breast Reconstruction -- Psychosocial Factors KW - Decision Making KW - Depression -- Etiology KW - Depression -- Therapy KW - Emotions KW - Patient Satisfaction KW - Truth Disclosure KW - Adult KW - Female KW - Middle Age KW - Questionnaires KW - Support, Psychosocial KW - Human SP - 342 EP - 351 JO - Psycho-Oncology JF - Psycho-Oncology JA - PSYCHO ONCOL VL - 16 IS - 4 CY - Hoboken, New Jersey PB - John Wiley & Sons, Inc. AB - Little is known of the psychosocial factors associated with decision regret in the context of breast reconstruction following mastectomy for breast cancer treatment. Moreover, there is a paucity of theoretically-based research in the area of post-decision regret. Adopting the theoretical framework of the Monitoring Process Model (Cancer 1995;76(1):167-177), the current study assessed the role of information satisfaction, current psychological distress and the moderating effect of monitoring coping style to the experience of regret over the decision to undergo reconstructive surgery. Women (N=123) diagnosed with breast cancer who had undergone immediate or delayed breast reconstruction following mastectomy participated in the study. The majority of participants (52.8%, n=65) experienced no decision regret, 27.6% experienced mild regret and 19.5% moderate to strong regret. Bivariate analyses indicated that decision regret was associated with low satisfaction with preparatory information, depression, anxiety and stress. Multinominal logistic regression analysis showed, controlling for mood state and time since last reconstructive procedure, that lower satisfaction with information and increased depression were associated with increased likelihood of experiencing regret. Monitoring coping style moderated the association between anxiety and regret (beta=-0.10, OR=0.91, p=0.01), whereby low monitors who were highly anxious had a greater likelihood of experiencing regret than highly anxious high monitors. SN - 1057-9249 U2 - PMID: 16874745. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105978740&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105950541 T1 - Decision aids and breast cancer: do they influence choice for surgery and knowledge of treatment options? AU - Waljee JF AU - Rogers MA AU - Alderman AK Y1 - 2007/03/20/ N1 - Accession Number: 105950541. Language: English. Entry Date: 20080201. Revision Date: 20150711. Publication Type: Journal Article; research; systematic review. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 8309333. KW - Attitude to Health KW - Breast Neoplasms -- Surgery KW - Counseling -- Methods KW - Decision Making KW - Mastectomy -- Methods KW - Patient Education KW - Attitude of Health Personnel KW - Breast Neoplasms -- Pathology KW - Breast Neoplasms -- Therapy KW - CINAHL Database KW - Conflict (Psychology) KW - Consumer Participation KW - Embase KW - Female KW - Medline KW - Neoplasm Staging KW - Odds Ratio KW - Patient Satisfaction KW - Physician-Patient Relations KW - Quality of Life KW - Treatment Outcomes KW - Human SP - 1067 EP - 1073 JO - Journal of Clinical Oncology JF - Journal of Clinical Oncology JA - J CLIN ONCOL VL - 25 IS - 9 CY - Alexandria, Virginia PB - American Society of Clinical Oncology AB - PURPOSE: To describe the effect of decision aids on the choice for surgery and knowledge of surgical therapy among women with early-stage breast cancer. METHODS: A systematic review was conducted between years 1966 to 2006 of all studies designed to assess the effect of decision aids on surgical therapy. MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health (CINAHL), the Cochrane Network, HAPI databases, and bibliographies were searched. Of the 123 studies screened, 11 studies met criteria. Meta-analyses were performed to assess the pooled relative risk for surgical choice and the pooled mean difference in patient knowledge. RESULTS: Results from randomized controlled trials indicated that women who used a decision aid were 25% more likely to choose breast-conserving surgery over mastectomy (risk ratio, 1.25; 95% CI, 1.11 to 1.40). Decision aids significantly increased patient knowledge by 24% (P = .024). The data also suggested that decision aids decreased decisional conflict and increased satisfaction with the decision-making process. Decision aids were well received by surgeons and patients, facilitated patients' desire for shared decision making, and were feasible to implement into practice. CONCLUSION: Decision aids are important adjuncts for counseling women with early-stage breast cancer. Their use increases the likelihood that women will choose breast-conserving surgery, and enhances patient knowledge of treatment options. SN - 0732-183X U2 - PMID: 17369570. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105950541&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106007965 T1 - Pilot Trial of a Computerized Decision Aid for Breast Cancer Prevention. AU - Ozanne EM AU - Annis C AU - Adduci K AU - Showstack J AU - Esserman L Y1 - 2007/03//Mar/Apr2007 N1 - Accession Number: 106007965. Language: English. Entry Date: 20080229. Revision Date: 20150711. Publication Type: Journal Article; clinical trial; research. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Peer Reviewed; USA. NLM UID: 9505539. KW - Breast Neoplasms -- Prevention and Control KW - Decision Making, Computer Assisted KW - Patient Education -- Methods KW - Adult KW - Aged KW - Attitude to Health KW - California KW - Clinical Trials KW - Consumer Participation KW - Female KW - Middle Age KW - Patient Satisfaction KW - Pilot Studies KW - Risk Assessment KW - Human SP - 147 EP - 154 JO - Breast Journal JF - Breast Journal JA - BREAST J VL - 13 IS - 2 CY - Malden, Massachusetts PB - Wiley-Blackwell AB - This study sought to evaluate a shared decision-making aid for breast cancer prevention care designed to help women make appropriate prevention decisions by presenting information about risk in context. The decision aid was implemented in a high-risk breast cancer prevention program and pilot-tested in a randomized clinical trial comparing standard consultations to use of the decision aid. Physicians completed training with the decision aid prior to enrollment. Thirty participants enrolled (15 per group) and completed measures of clinical feasibility and effectiveness prior to, immediately after, and at 9 months after their consultations. The decision aid was feasible to use during the consultations as measured by consultation duration, user satisfaction, patient knowledge, and decisional conflict. The mean consultation duration was not significantly different between groups (24 minutes for intervention group versus 21 minutes for control group, p = 0.42). The majority found the decision aid acceptable and useful and would recommend it to others. Both groups showed an improvement in breast cancer prevention knowledge postvisit, which was significant in the intervention group (p = 0.01) but not the control group (p = 0.13). However, the knowledge scores returned to baseline at follow-up in both groups. Decision preference for patients who chose chemoprevention post consultations remained constant at follow-up for the intervention group, but not for the control group. The decision framework provides access to key information during consultations and facilitates the integration of emerging biomarkers in this setting. Initial results suggest that the decision aid is feasible for use in the consultation room. The tendency for the decision choices and knowledge scores to return to baseline at follow-up suggests the need for initial and ongoing prevention decision support. SN - 1075-122X U2 - PMID: 17319855. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106007965&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106169534 T1 - Acupuncture for chemotherapy-associated cognitive dysfunction: a hypothesis-generating literature review to inform clinical advice. AU - Johnston MF AU - Yang C AU - Hui K AU - Xiao B AU - Li X AU - Rusiewicz A Y1 - 2007/03// N1 - Accession Number: 106169534. Language: English. Entry Date: 20071012. Revision Date: 20150711. Publication Type: Journal Article; review; tables/charts. Journal Subset: Alternative/Complementary Therapies; Biomedical; Peer Reviewed; USA. Instrumentation: Global Assessment of Functioning Scale (GAF); Clinical Global Impressions Scale; Bech-Rafaelson Melancholia Scale. NLM UID: 101128834. KW - Acupuncture KW - Antineoplastic Agents -- Adverse Effects KW - Cognition Disorders -- Therapy KW - Neoplasms -- Drug Therapy KW - Bech-Rafaelson Melancholia Scale KW - Breast Neoplasms -- Drug Therapy KW - Breast Neoplasms -- Psychosocial Factors KW - Chemotherapy, Adjuvant -- Adverse Effects KW - Cognition Disorders -- Chemically Induced KW - Models, Biological KW - Nervous System Diseases -- Therapy KW - Psychological Tests SP - 36 EP - 41 JO - Integrative Cancer Therapies JF - Integrative Cancer Therapies JA - INTEGR CANCER THER VL - 6 IS - 1 CY - Thousand Oaks, California PB - Sage Publications Inc. AB - There is an emerging consensus that between one fifth and one half of breast cancer patients experience chemotherapy-associated cognitive dysfunction. Research shows that patients with cancer are often interested in acupuncture for symptom relief. A clinical question thus arises: What should physicians advise their patients regarding the use of acupuncture to alleviate or ameliorate chemotherapy-associated cognitive dysfunction? The authors review and synthesize 2 bodies of relevant research literature: (1) the developing literature on the etiology and nature of chemotherapy-associated cognitive dysfunction and (2) the literature concerning acupuncture for neurological diseases and psychological issues. There is evidence that acupuncture may be effectively used to manage a range of psychoneurological issues, some of which are similar to those experienced by patients with chemotherapy-associated cognitive dysfunction. The evidence of efficacy is more promising for psychological than neurological conditions. Given evidence of possible efficacy combined with evidence of demonstrated safety, we suggest that physicians should support patient decisions to use acupuncture services for chemotherapy-associated cognitive dysfunction, especially given the lack of proven alternatives. SN - 1534-7354 AD - Center for East-West Medicine, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles. johnston@ucla.edu. U2 - PMID: 17351025. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106169534&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106018150 T1 - Addressing the need for adaptable decision processes within healthcare software. AU - Miseldine P AU - Taleb-Bendiab A AU - England D AU - Randles M Y1 - 2007/03// N1 - Accession Number: 106018150. Language: English. Entry Date: 20071207. Revision Date: 20150819. Publication Type: Journal Article. Journal Subset: Biomedical; Computer/Information Science; Europe; Peer Reviewed; UK & Ireland. NLM UID: 100883495. KW - Decision Making, Computer Assisted KW - Medical Informatics KW - Software Design KW - Breast Neoplasms KW - Dental Care KW - Great Britain KW - Triage SP - 35 EP - 41 JO - Medical Informatics & the Internet in Medicine JF - Medical Informatics & the Internet in Medicine JA - MED INFORM INTERNET MED VL - 32 IS - 1 CY - Philadelphia, Pennsylvania PB - Taylor & Francis Ltd AB - In the healthcare sector, where the decisions made by software aid in the direct treatment of patients, software requires high levels of assurance to ensure the correct interpretation of the tasks it is automating. This paper argues that introducing adaptable decision processes within eHealthcare initiatives can reduce software-maintenance complexity and, due to the instantaneous, distributed deployment of decision models, allow for quicker updates of current best practice, thereby improving patient care. The paper provides a description of a collection of technologies and tools that can be used to provide the required adaptation in a decision process. These tools are evaluated against two case studies that individually highlight different requirements in eHealthcare: a breast-cancer decision-support system, in partnership with several of the UK's leading cancer hospitals, and a dental triage in partnership with the Royal Liverpool Hospital which both show how the complete process flow of software can be abstracted and adapted, and the benefits that arise as a result. SN - 1463-9238 AD - Liverpool John Moores University. Liverpool. UK. U2 - PMID: 17365643. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106018150&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105856359 T1 - Should the extent of lobular neoplasia on core biopsy influence the decision for excision? AU - Esserman LE AU - Lamea L AU - Tanev S AU - Poppiti R Y1 - 2007/01//Jan/Feb2007 N1 - Accession Number: 105856359. Language: English. Entry Date: 20080314. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Peer Reviewed; USA. NLM UID: 9505539. KW - Biopsy KW - Breast Neoplasms -- Surgery KW - Decision Support Techniques KW - Neoplasms, Ductal, Lobular, and Medullary -- Surgery KW - Adult KW - Aged KW - Aged, 80 and Over KW - Breast Neoplasms -- Epidemiology KW - Breast Neoplasms -- Pathology KW - Female KW - Florida KW - Medical Records KW - Middle Age KW - Neoplasms, Ductal, Lobular, and Medullary -- Epidemiology KW - Neoplasms, Ductal, Lobular, and Medullary -- Pathology KW - Retrospective Design KW - Human SP - 55 EP - 61 JO - Breast Journal JF - Breast Journal JA - BREAST J VL - 13 IS - 1 CY - Malden, Massachusetts PB - Wiley-Blackwell AB - The purpose of this study was to determine whether there is a criterion that can be utilized to determine if excisional biopsy is indicated following the diagnosis of lobular neoplasia (LN) on core biopsy. Retrospective review of patient records with diagnosis of LN as highest risk diagnosis on core biopsy was performed. LN was defined to include both atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS) and was categorized as focal or diffuse. The pathology was correlated with the mammographic finding to determine whether the diagnosis of LN was incidental or related to the mammographic finding. For those patients who did not undergo excision, follow-up data are presented along with treatment information. A total of 4,555 breast core biopsies were performed at our institution from January 1997 through March 2005. Of these, 35 patients were diagnosed with LN. Twenty six (74%) went on to excision and nine (26%) were followed. Biopsy was recommended for mammographically detected calcifications in the majority of cases. Twenty four (92%) of the 26 excised cases had focal LN and 2 of 26 (8%) had diffuse LN. Infiltrating lobular carcinoma was diagnosed in both cases of diffuse LN and no infiltrating carcinoma was seen when focal LN was diagnosed on core. Excision may not be necessary when a diagnosis of only focal LN is made on core biopsy. Diffuse LN may indicate an associated invasive cancer and should prompt excision. SN - 1075-122X AD - Breast Imaging, Mount Sinai medical Center, Miami Beach, Florida 33140, USA. lesserman@aol.com U2 - PMID: 17214794. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105856359&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106265780 T1 - Exploring the black box of a decision aid: what information do patients select from an interactive Cd-Rom on treatment options in breast cancer? AU - Molenaar S AU - Sprangers M AU - Oort F AU - Rutgers E AU - Luiten E AU - Mulder J AU - van Meeteren M AU - de Haes H Y1 - 2007/01// N1 - Accession Number: 106265780. Language: English. Entry Date: 20070413. Revision Date: 20150711. Publication Type: Journal Article; pictorial; research; tables/charts. Journal Subset: Core Nursing; Europe; Health Promotion/Education; Nursing; Peer Reviewed; UK & Ireland. Instrumentation: MOS20 subscale [Dutch]; Decision Uncertainty subscale [Dutch]; Michigan assessment of decision style (MADS). NLM UID: 8406280. KW - Breast Neoplasms -- Psychosocial Factors KW - CD ROM -- Standards KW - Computer Assisted Instruction KW - Decision Making, Patient KW - Patient Education -- Methods KW - Adaptation, Psychological KW - Adult KW - Aged KW - Aged, 80 and Over KW - Analysis of Variance KW - Breast Neoplasms -- Surgery KW - Communication KW - Comparative Studies KW - Consent KW - Consumer Participation -- Methods KW - Consumer Participation -- Psychosocial Factors KW - Convenience Sample KW - Descriptive Statistics KW - Female KW - Health Services Needs and Demand KW - Mastectomy -- Education KW - Mastectomy -- Psychosocial Factors KW - Middle Age KW - Netherlands KW - Pretest-Posttest Design KW - Prospective Studies KW - Psychological Tests KW - Questionnaires KW - Summated Rating Scaling KW - T-Tests KW - Uncertainty KW - User-Computer Interface KW - Human SP - 122 EP - 130 JO - Patient Education & Counseling JF - Patient Education & Counseling JA - PATIENT EDUC COUNS VL - 65 IS - 1 PB - Elsevier B.V. AB - OBJECTIVE: It is thought that patients fare better when they participate in treatment decision-making, and when they have more control over the amount and type of information they receive. To facilitate informed decision-making, interactive decision aids have been introduced in health care. This article describes how much, and which information patients select from an interactive decision aid on breast cancer. To explore whether the interactive system facilitates that different patients receive different information, associations between patients' characteristics and information selection are inspected. METHODS: The interactive decision aid was provided to 106 patients after an initial discussion with their surgeon about their diagnosis and treatment options. Information regarding patients' age, completed education, treatment preference, psychological functioning, decision uncertainty and decision style was collected with a written, structured questionnaire. The questionnaire was completed before patients used the interactive decision aid. To create categories, a median-split procedure was employed on the scores of the continuous background variables. The information patients selected from the interactive decision aid were registered into logfiles. Associations between patients' background variables and information selection were investigated by means of univariate statistics. RESULTS: Patients (n=97; 92%) used the interactive decision aid intensively. On average, patients spent almost 70min searching for information and selected 21 information topics. Overall, treatment related information was clearly more selected than other types of information. Age, education, and decision style factors were associated with information selection. CONCLUSION: The interactive breast cancer decision aid was utilized intensively. The interactive system was found to facilitate that different patients received different amounts and types of information. PRACTICE IMPLICATIONS: Interactive decision aids may improve information giving to patients, and as a result, the quality of care. To safeguard informed-choice, decision aids should be used in conjunction with other communication strategies. Decision aids should be available continuously and throughout the patients' disease journey. The Internet may help to achieve broad dissemination and enduring access. SN - 0738-3991 AD - Academic Medical Center, University of Amsterdam, Department of Medical Psychology (Room J3-401), P.O. Box 22 660, 1100 DD Amsterdam, The Netherlands. J.Molenaar@AMC.UvA.NL U2 - PMID: 16945498. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106265780&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106225274 T1 - An informed decision? Breast cancer patients and their knowledge about treatment. AU - Fagerlin A AU - Lakhani I AU - Lantz PM AU - Janz NK AU - Morrow M AU - Schwartz K AU - Deapen D AU - Salem B AU - Liu L AU - Katz SJ Y1 - 2006/12// N1 - Accession Number: 106225274. Language: English. Entry Date: 20070126. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Core Nursing; Europe; Health Promotion/Education; Nursing; Peer Reviewed; UK & Ireland. Grant Information: National Cancer Institute (RO1 CA8837-A1); the National Cancer Institute, National Institutes of Health, Dept of Health and Human Services, under Contract Nos. N01-PC-35139 and NO1-PC-65064; MREP Early Cancer Award from the US Dept of Veterans Affairs, and the California Dept of Health Services. NLM UID: 8406280. KW - Breast Neoplasms KW - Cancer Patients -- United States KW - Health Knowledge -- Evaluation KW - Patient Education -- Evaluation -- United States KW - Aged KW - Confidence Intervals KW - Decision Making, Patient KW - Descriptive Statistics KW - Female KW - Funding Source KW - Literacy KW - Logistic Regression KW - Middle Age KW - Odds Ratio KW - Questionnaires KW - Summated Rating Scaling KW - Surveys KW - United States KW - Human SP - 303 EP - 312 JO - Patient Education & Counseling JF - Patient Education & Counseling JA - PATIENT EDUC COUNS VL - 64 IS - 1-3 PB - Elsevier B.V. AB - OBJECTIVE: Although involving women in breast cancer treatment decisions is advocated, there is little understanding of whether women have the information they need to make informed decisions. The objective of the current study was to evaluate women's knowledge of survival and recurrence rates for mastectomy and breast conserving surgery (BCS) and the factors associated with this knowledge. METHODS: We used a population-based sample of women diagnosed with breast cancer in metropolitan Los Angeles and Detroit between December 2001 and January 2003. All women with ductal carcinoma in situ and a random sample of women with invasive disease were selected (N=2382), of which 1844 participated (77.4%). All participants were mailed surveys. The main outcome measures were knowledge of survival and recurrence rates by surgical treatment type. RESULTS: Only 16% of women knew that recurrence rates were different for mastectomy and BCS, and 48% knew that the survival rates were equivalent across treatment. Knowledge about survival and recurrence was improved by exposure to the Internet and health pamphlets (p<0.01). Women who had a female (versus male) surgeon, and/or a surgeon who explained both treatments (rather than just one treatment) demonstrated higher survival knowledge (p<0.01). The majority of women had inadequate knowledge with which to make informed decisions about breast cancer surgical treatment. CONCLUSION: Previous explanations for poor knowledge, such as irrelevance of knowledge to decision making and lack of access to information, were not shown to be plausible explanations for the low levels of knowledge observed in this sample. PRACTICE IMPLICATIONS: These results suggest a need for fundamental changes in patient education to ensure that women are able to make informed decisions about their breast cancer treatment. These changes may include an increase in the use of decision aids and in decreasing the speed at which treatment decisions are made. SN - 0738-3991 AD - VA HealthServices Research and Development Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System, Ann Arbor, MI U2 - PMID: 16860523. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106225274&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106155038 T1 - A decision aid to assist in adjuvant therapy choices for breast cancer. AU - Siminoff LA AU - Gordon NH AU - Silverman P AU - Budd T AU - Ravdin PM Y1 - 2006/11// N1 - Accession Number: 106155038. Language: English. Entry Date: 20070914. Revision Date: 20150711. Publication Type: Journal Article; clinical trial; research; tables/charts. Journal Subset: Biomedical; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. NLM UID: 9214524. KW - Antineoplastic Agents -- Administration and Dosage KW - Antineoplastic Agents, Hormonal -- Administration and Dosage KW - Breast Neoplasms -- Drug Therapy KW - Decision Making, Patient KW - Tamoxifen -- Administration and Dosage KW - Adult KW - Aged KW - Antineoplastic Agents -- Adverse Effects KW - Antineoplastic Agents, Hormonal -- Adverse Effects KW - Breast Neoplasms -- Mortality KW - Breast Neoplasms -- Pathology KW - Breast Neoplasms -- Prognosis KW - Breast Neoplasms -- Surgery KW - Chemotherapy, Adjuvant KW - Clinical Trials KW - Consumer Participation -- Trends KW - Female KW - Male KW - Middle Age KW - Neoplasm Staging KW - Probability KW - Registries, Disease KW - Tamoxifen -- Adverse Effects KW - United States KW - Human SP - 1001 EP - 1013 JO - Psycho-Oncology JF - Psycho-Oncology JA - PSYCHO ONCOL VL - 15 IS - 11 CY - Hoboken, New Jersey PB - John Wiley & Sons, Inc. AB - Background: Decision aids are tools that help patients make specific and deliberative choices among options. This study was a group randomized controlled trial of a novel decision aid to help patients with breast cancer make adjuvant therapy (AT) decisions.Methods: Fourteen oncology practices (n=58 physicians) were randomized to receive the decision aid or a control pamphlet. Complete data were obtained from 405 patient-oncologist pairs. Eligible patients had stage I-III disease and had completed their primary treatment. The decision aid is a simple to use computer program, titled Adjuvant!, that provides estimates of outcome with and without AT. Graphical representations of outcome are shared with patients. Consultations were audiotaped, patients interviewed, and physicians completed a self-administered survey.Results: In a multivariable model, the 54 patients (13.3%) who took no AT were more likely to have received the decision aid (p=0.02). A differential effect of the Adjuvant! Decision Guide was noted between node negative and positive patients. It was stated by 86.2% of patients that the decision aid was influential when making their treatment decision. Over 95% of patients reported that the Adjuvant Decision Guide was easy to understand and 75% of physicians believed that it helped them understand their patient's treatment preferences and 81.4% reported the information as useful for themselves.Conclusions: This study showed that a decision aid made a difference in the choice of whether or not to take AT. The decision aid allowed patients and physicians to consider the benefits of AT in an easy to understand format. Treatment decisions were more individualized for patients in the intervention than in the control group. The use of the decision aid was acceptable to both patients and physicians. Copyright (c) 2006 John Wiley & Sons, Ltd. SN - 1057-9249 AD - Case Western Reserve University, USA. U2 - PMID: 16511899. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106155038&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106294319 T1 - Clinical role of proton magnetic resonance spectroscopy in oncology: brain, breast, and prostate cancer. AU - Kwock L AU - Smith JK AU - Castillo M AU - Ewend MG AU - Collichio F AU - Morris DE AU - Bouldin TW AU - Cush S Y1 - 2006/10// N1 - Accession Number: 106294319. Language: English. Entry Date: 20070601. Revision Date: 20150711. Publication Type: Journal Article; diagnostic images; review; tables/charts. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. NLM UID: 100957246. KW - Magnetic Resonance Spectroscopy -- Methods KW - Oncology -- Methods KW - Brain Neoplasms -- Diagnosis KW - Breast Neoplasms -- Diagnosis KW - Female KW - Male KW - Prostatic Neoplasms -- Diagnosis KW - Protons KW - Reproducibility of Results SP - 859 EP - 868 JO - Lancet Oncology JF - Lancet Oncology JA - LANCET ONCOL VL - 7 IS - 10 CY - New York, New York PB - Elsevier B.V. AB - Standardised proton magnetic resonance spectroscopic imaging (MRSI) was initially developed for routine in-situ clinical assessment of human brain tumours, and its use was later extended for examination of prostate and breast cancers. MRSI coupled with both routine and functional MRI techniques provides more detailed information about a tumour's location and extent of its infiltration than any other modality alone. Information obtained by adding MRSI data to anatomical and functional MRI findings aid in clinical management decisions (such as watchful waiting vs immediate intervention). In this Review, we discuss the current status of proton MRSI, with emphasis on its clinical use to map the location and extent of tumour processes for spectroscopic image-guided biopsy procedures and to monitor treatment paradigms for brain, prostate, and breast cancer. SN - 1470-2045 AD - Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA. U2 - PMID: 17012048. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106294319&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106280601 T1 - The impact of context on evidence utilization: a framework for expert groups developing health policy recommendations. AU - Dobrow MJ AU - Goel V AU - Lemieux-Charles L AU - Black NA Y1 - 2006/10// N1 - Accession Number: 106280601. Language: English. Entry Date: 20070511. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Allied Health; Biomedical; Continental Europe; Double Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed. NLM UID: 8303205. KW - Cancer Screening KW - Health Policy KW - Neoplasms -- Prevention and Control KW - Policy Making KW - Breast Neoplasms -- Epidemiology KW - Breast Neoplasms -- Prevention and Control KW - Canada KW - Cervix Neoplasms -- Epidemiology KW - Cervix Neoplasms -- Prevention and Control KW - Colorectal Neoplasms -- Epidemiology KW - Colorectal Neoplasms -- Prevention and Control KW - Decision Making KW - Female KW - Health and Welfare Planning KW - Interviews KW - Male KW - Medical Practice, Evidence-Based KW - Politics KW - Prostatic Neoplasms -- Epidemiology KW - Prostatic Neoplasms -- Prevention and Control KW - Human SP - 1811 EP - 1824 JO - Social Science & Medicine JF - Social Science & Medicine JA - SOC SCI MED VL - 63 IS - 7 PB - Pergamon Press - An Imprint of Elsevier Science AB - Should the same evidence lead to the same decision outcomes in different decision-making contexts? In order to improve comprehension of this issue, this study considers how context influences evidence utilization in the development of health policy recommendations. We used an embedded multiple case study design to study how four expert groups formulated policy recommendations for breast, cervical, colorectal, and prostate cancer screening in Ontario, Canada. We interviewed expert group members and analysed meeting agendas/minutes, interim/final reports and other case-related documents. Our analyses revealed varying policy objectives; the use, neglect, or overextended consideration of three key decision support tools; the varying skills/abilities of expert group members in using different decision support tools; the varying impact of effect modifiers, resource constraints and political interests; and the differing development/consideration of context-specific evidence to address uncertainty in the external decision-making context. While more work is needed to determine if these findings are generalizable beyond cancer screening policy, we believe the central challenge for evidence-based policy is not to develop international evidence, but rather to develop more systematic, rigorous, and global methods for identifying, interpreting, and applying evidence in different decision-making contexts. Our analyses suggest that identification of evidence must distinguish between different policy objectives in order to link a broad conceptualization of evidence to appropriate policy questions. Interpretation of evidence must acknowledge the varying nature of evidence for different policy objectives, balancing existing emphasis on evidentiary quality with more sophisticated methods for assessing the generalizability of evidence. The application of evidence must also acknowledge different policy objectives, appropriately employing rule-based grading schemes and agreement-based consensus methods that are sensitive to the nature of the evidence and contexts involved. SN - 0277-9536 AD - Department of Health Policy, Management and Evaluation, University of Toronto, Canada. U2 - PMID: 16764980. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106280601&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105998079 T1 - Toward optimized breast cancer care with east/west-linked wisdom. AU - Tajima T Y1 - 2006/09/02/Sep2006 Supplement N1 - Accession Number: 105998079. Language: English. Entry Date: 20080222. Revision Date: 20150711. Publication Type: Journal Article; editorial. Supplement Title: Sep2006 Supplement. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Peer Reviewed; USA. NLM UID: 9505539. KW - Breast Neoplasms -- Prevention and Control KW - Medical Organizations -- Administration KW - Quality of Health Care KW - Decision Support Techniques KW - Female KW - International Relations KW - Japan KW - World Health SP - S126 EP - 7 JO - Breast Journal JF - Breast Journal JA - BREAST J VL - 12 CY - Malden, Massachusetts PB - Wiley-Blackwell SN - 1075-122X U2 - PMID: 16958991. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105998079&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105998069 T1 - Paradigm shift of staging and treatment for early breast cancer in the sentinel lymph node era. AU - Leong SPL Y1 - 2006/09/02/Sep2006 Supplement N1 - Accession Number: 105998069. Language: English. Entry Date: 20080222. Revision Date: 20150711. Publication Type: Journal Article. Supplement Title: Sep2006 Supplement. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Peer Reviewed; USA. NLM UID: 9505539. KW - Breast Neoplasms -- Pathology KW - Sentinel Lymph Node Biopsy KW - Breast Neoplasms -- Diagnosis KW - Breast Neoplasms -- Therapy KW - Decision Support Techniques KW - Female KW - Neoplasm Metastasis KW - Neoplasm Staging KW - Tumor Markers, Biological SP - S128 EP - 33 JO - Breast Journal JF - Breast Journal JA - BREAST J VL - 12 CY - Malden, Massachusetts PB - Wiley-Blackwell AB - Lymph node status is the most reliable prognostic indicator for the clinical outcome of patients with most solid cancers. Because it is the first node draining the primary cancer, the sentinel lymph node (SLN) is most likely to harbor metastatic cancer cells. The tumor size of primary breast cancer is highly correlated with SLN metastasis. If the SLN is negative, the negative predictive value of the remaining nodal basin exceeds 95%. It appears that even using different techniques from different institutions, the successful rate to harvest the SLN is more than 95%. The false-negative rate is about 5-10% in most series. Breast cancer patients with early detection and a negative SLN have a significantly improved survival rate. The SLN data in breast cancer is so convincing that SLN information has been incorporated into the new American Joint Committee on Cancer (AJCC) classification of breast cancer. The therapeutic value of additional lymph node dissection after a positive SLN for breast cancer is still controversial. Follow-up data from breast cancer patients is somewhat limited, but available information shows that patients with negative SLNs fare much better. In summary, several important patterns of metastasis can be established based on the current SLN experience: 1) The earlier the breast cancer is found, the less the metastatic potential. 2) In most cases, breast cancer follows an orderly progression of metastasis to the SLN. 3) A small subgroup of patients may develop systemic dissemination without SLN involvement. Since metastatic cancer is usually incurable, it is important for oncologists to detect and resect an early breast cancer without delay. The challenge in the future will be to dissect these different patterns of metastasis based on molecular or genetic markers. Such information will be critical to select high-risk patients for adjuvant therapy. SN - 1075-122X AD - Department of Surgery, University of California and UCSF Comprehensive Cancer Center at MountZion, 1600 Divisadero St., Room C333, San Francisco, CA 94143-1674; ; leongs@surgery.ucsf.edu U2 - PMID: 16958992. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105998069&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105998093 T1 - Pathologic examination of the sentinel lymph node: what is the best method? AU - Treseler P Y1 - 2006/09/02/Sep2006 Supplement N1 - Accession Number: 105998093. Language: English. Entry Date: 20080222. Revision Date: 20150711. Publication Type: Journal Article; research. Supplement Title: Sep2006 Supplement. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Peer Reviewed; USA. NLM UID: 9505539. KW - Breast Neoplasms -- Pathology KW - Sentinel Lymph Node Biopsy KW - Breast Neoplasms -- Mortality KW - Decision Support Techniques KW - Female KW - Immunohistochemistry KW - Neoplasm Metastasis KW - Polymerase Chain Reaction KW - Prognosis KW - Survival Analysis KW - Tumor Markers, Biological KW - Human SP - S143 EP - 51 JO - Breast Journal JF - Breast Journal JA - BREAST J VL - 12 CY - Malden, Massachusetts PB - Wiley-Blackwell AB - Sentinel lymph node biopsy (SLNB) has become an acceptable alternative to complete axillary dissection to determine whether breast cancer has spread to axillary lymph nodes. Yet the best method for pathologic examination of the sentinel lymph node (SLN) remains controversial. For years there has been speculation that micrometastases in axillary lymph nodes were clinically insignificant and thus lymph nodes did not require sectioning at close intervals. Yet essentially all studies, including a recent large prospective study, have found a significantly poorer prognosis associated even with metastases less than 2 mm in size-the most common definition of micrometastasis-suggesting that such small metastases cannot be safely overlooked. The use of immunohistochemistry (IHC) to detect keratin proteins will reveal metastatic breast carcinoma in about 18% of axillary lymph nodes that appear negative on routine stains. The preponderance of evidence to date suggests a significantly poorer prognosis in patients with such occult metastases, although data from large prospective studies are lacking. Molecular techniques such as polymerase chain reaction (PCR) offer even more sensitive methods for detecting occult metastasis in SLNs, although false positives are a particular problem in techniques that do not permit morphologic correlation, and for now they remain a research tool. Intraoperative examination of the SLN permits a completion axillary dissection to be performed during the same procedure if metastatic tumor is found; however, intraoperative techniques such as cytologic examination and frozen section lack sensitivity, and can result in loss of up to 50% of the SLN tissue. A proposal for optimal pathologic examination of the SLN is offered based on the above data. SN - 1075-122X AD - Departmenr of Pathology, Box 0102, University of California San Francisco, 505 Parnassus Ave., Room M545, San Francisco, CA 94143-0105 U2 - PMID: 16958994. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105998093&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105944734 T1 - Decision aids for familial breast cancer: exploring women's views using focus groups. AU - Rapport F AU - Iredale R AU - Jones W AU - Sivell S AU - Edwards A AU - Gray J AU - Elwyn G Y1 - 2006/09// N1 - Accession Number: 105944734. Language: English. Entry Date: 20080125. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Europe; Health Services Administration; Peer Reviewed; UK & Ireland. NLM UID: 9815926. KW - Breast Neoplasms KW - Decision Making KW - Genetic Screening -- Psychosocial Factors KW - Women -- Psychosocial Factors KW - Adult KW - CD ROM KW - Female KW - Focus Groups KW - Great Britain KW - Pilot Studies KW - Risk Assessment KW - Human SP - 232 EP - 244 JO - Health Expectations JF - Health Expectations JA - HEALTH EXPECTATIONS VL - 9 IS - 3 CY - Malden, Massachusetts PB - Wiley-Blackwell SN - 1369-6513 U2 - PMID: 16911137. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105944734&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105944735 T1 - Decision aids in routine practice: lessons from the breast cancer initiative. AU - Silvia KA AU - Sepucha KR Y1 - 2006/09// N1 - Accession Number: 105944735. Language: English. Entry Date: 20080125. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Europe; Health Services Administration; Peer Reviewed; UK & Ireland. NLM UID: 9815926. KW - Breast Neoplasms -- Psychosocial Factors KW - Breast Neoplasms -- Surgery KW - Decision Making KW - Academic Medical Centers KW - Adult KW - Community Health Centers KW - Female KW - Interviews KW - Pilot Studies KW - Human SP - 255 EP - 264 JO - Health Expectations JF - Health Expectations JA - HEALTH EXPECTATIONS VL - 9 IS - 3 CY - Malden, Massachusetts PB - Wiley-Blackwell SN - 1369-6513 U2 - PMID: 16911140. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105944735&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106163403 T1 - Entertainment education for informed breast cancer treatment decisions in low-literate women: development and initial evaluation of a patient decision aid. AU - Jibaja-Weiss ML AU - Volk RJ AU - Granchi TS AU - Neff NE AU - Spann SJ AU - Aoki N AU - Robinson EK AU - Freidman LC AU - Beck JR Y1 - 2006/09// N1 - Accession Number: 106163403. Language: English. Entry Date: 20071005. Revision Date: 20150711. Publication Type: Journal Article; algorithm; pictorial; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Health Promotion/Education; Peer Reviewed; USA. Instrumentation: Satisfaction With Program Questionnaire. Grant Information: Grant DAMD17-98-1-8022 from the US Army Medical Research and Materiel Command. NLM UID: 8610343. KW - Breast Neoplasms -- Therapy KW - Cancer Patients -- Education KW - Decision Making, Computer Assisted KW - Decision Making, Patient KW - Patient Education KW - Attitude Measures KW - Blacks KW - Chemotherapy, Cancer KW - Descriptive Statistics KW - Drama KW - Female KW - Funding Source KW - Graphical User Interface KW - Health Knowledge KW - Hispanics KW - Hospitals, Public KW - Interviews KW - Literacy KW - Mastectomy KW - McNemar's Test KW - Middle Age KW - P-Value KW - Patient Satisfaction KW - Program Development KW - Questionnaires KW - Radiotherapy KW - Random Assignment KW - Texas KW - Whites KW - Human SP - 133 EP - 139 JO - Journal of Cancer Education JF - Journal of Cancer Education JA - J CANCER EDUC VL - 21 IS - 3 CY - , PB - Springer Science & Business Media B.V. AB - Background: We report on the development and initial evaluation of a novel computerized decision support system (CDSS) that utilizes concepts from entertainment education (edutainment) to assist low-literate, multiethnic women in making initial surgical treatment decisions. Method: We randomly assigned 51 patients diagnosed with early stage breast cancer to use the decision aid. Results: Patients who viewed the CDSS improved their knowledge of breast cancer treatment; found the application easy to use and understand, informative, and enjoyable; and were less worried about treatment. Conclusion: The system clearly reached its intended objectives to create a usable decision aid for low-literate, novice computer users. SN - 0885-8195 AD - Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX U2 - PMID: 17371175. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106163403&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105849163 T1 - Molecular classification of breast cancer: limitations and potential. AU - Pusztai L AU - Mazouni C AU - Anderson K AU - Wu Y AU - Symmans WF Y1 - 2006/09// N1 - Accession Number: 105849163. Language: English. Entry Date: 20080314. Revision Date: 20150711. Publication Type: Journal Article. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 9607837. KW - Breast Neoplasms -- Classification KW - Breast Neoplasms KW - Molecular Biology -- Classification KW - Biochips KW - Genes KW - Genetic Techniques KW - Neoplasm Staging KW - Proteins KW - Quality Assessment -- Standards KW - Quality Assessment -- Trends KW - Tumor Markers, Biological SP - 868 EP - 877 JO - Oncologist JF - Oncologist JA - ONCOLOGIST VL - 11 IS - 8 CY - Durham, North Carolina PB - AlphaMed Company, Inc., dba AlphaMed Press AB - Reverse transcription polymerase chain reaction and DNA microarrays are increasingly used in the clinic and in clinical research as prognostic or predictive tests. Results from these tests led to novel risk stratification methods and to new molecular classification of breast cancer. Some of these tools already complement existing diagnostic tests and can aid medical decision making in some situations. Better understanding of the molecular classes of breast cancer, independent of their prognostic and predictive values, may also lead to new biological insights and eventually to better therapies that are directed toward particular molecular subsets. However, there is substantially less experience with these emerging technologies than with the more established methods, the accuracy of which is often overestimated. This review discusses some of the limitations and strengths of current gene expression-based molecular classification of breast cancer. To provide context for this discussion, we also briefly examine the performance of estrogen receptor immunohistochemistry, which represents an essential part of the routine diagnostic workup for all breast cancer patients. SN - 1083-7159 AD - D.Phil., University of Texas M.D. Anderson Cancer Center, Department of Breast Medical Oncology, Unit1354, PO Box 301439, Houston, Texas 77230-1439, USA. lpusztai@mdanderson.org U2 - PMID: 16951390. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105849163&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106228700 T1 - Evaluating radiological technologist's ability to detect abnormalities in film-screen mammographic images: a decision analysis pilot project. AU - Holt JJ Y1 - 2006///2006 Summer N1 - Accession Number: 106228700. Language: English. Entry Date: 20070202. Revision Date: 20150820. Publication Type: Journal Article; research; tables/charts. Journal Subset: Allied Health; Canada; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed. NLM UID: 8710791. KW - Breast Neoplasms -- Diagnosis KW - Competency Assessment KW - Mammography KW - Radiologic Technologists KW - Comparative Studies KW - Confidence KW - Descriptive Statistics KW - Job Experience KW - Pilot Studies KW - Predictive Value of Tests KW - Questionnaires KW - Radiologists KW - Scales KW - Sensitivity and Specificity KW - Human SP - 24 EP - 29 JO - Canadian Journal of Medical Radiation Technology JF - Canadian Journal of Medical Radiation Technology JA - CAN J MED RADIAT TECHNOL VL - 37 IS - 2 PB - Canadian Association of Medical Radiation Technologists AB - Purpose: To determine the radiological technologist's performance in detecting abnormalities in film-screen mammographic images.Methods: Fifty sets of 2-view bilateral mammographic images were read and judged to be either benign, likely benign, suspicious of abnormality or highly suggestive of malignancy. Seven readers, 5 radiological technologists and 2 radiologists currently working in the field of mammography participated in this study.Results: The sensitivity of three-fifths of the technologists in detecting abnormalities that were likely to be a sign of breast cancer was 100%, which was comparable to the 2 participating radiologists. Specificity was also high amongst the technologists, with three-fifths being equal to (88.37%) or better (93.02%) than that of the radiologists (88.37%).Conclusion: Of those participating in this study, the findings indicate that the sensitivity and specificity of the majority of individual technologists to detect mammographic abnormalities is comparable to that of the radiologists when compared to the gold standard. SN - 0820-5930 AD - British Columbia Institute of Technology, Burnaby, BC UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106228700&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106356196 T1 - A preference-based index for the SF-12. AU - Stratmann-Schoene D AU - Kuehn T AU - Kreienberg R AU - Leidl R Y1 - 2006/06// N1 - Accession Number: 106356196. Language: English. Entry Date: 20061103. Revision Date: 20150711. Publication Type: Journal Article; equations & formulas; research; tables/charts. Journal Subset: Europe; Health Services Administration; Peer Reviewed; UK & Ireland. Instrumentation: Short Form 12 Health Survey (SF-12). NLM UID: 9306780. KW - Health Status KW - Questionnaires KW - Aged KW - Algorithms KW - Attitude Measures KW - Breast Neoplasms -- Psychosocial Factors KW - Breast Neoplasms -- Surgery KW - Cancer Survivors KW - Descriptive Statistics KW - Female KW - Germany KW - Instrument Validation KW - Interviews KW - Middle Age KW - Pain Measurement KW - Psychometrics KW - Quality of Life KW - Surveys KW - Visual Analog Scaling KW - Human SP - 553 EP - 564 JO - Health Economics JF - Health Economics JA - HEALTH ECON VL - 15 IS - 6 CY - Hoboken, New Jersey PB - John Wiley & Sons, Inc. AB - Background: The SF-12 is a widely used generic measure of subjective health. As the scoring algorithms of the SF-12 do not include preference values, different approaches to assign a preference-based index are available that should be tested regarding their feasibility and validity.Objectives: To develop a concept for a preference-based index for the SF-12 on the basis of multi-attribute decision analysis and to perform initial tests of its feasibility and validity in an empirical study.Methods: A multi-attribute preference function for the SF-12 was developed, estimated and tested for validity. Two mail surveys (n = 100, 200) and an interview (n = 72) were conducted with women who had an operation for breast cancer. Visual analogue scale (VAS) and standard gamble (SG) measures elicited preference-based valuations.Results: Eight attributes were identified in the SF-12. Validity tests showed an average difference of 8 VAS score points between directly measured and predicted values for given health states.Conclusion: The initial results show that this approach might allow the direct assignment of a preference-based valuation to the SF-12. The quality of the psychometric features of the multi-attribute value function is encouraging. Future studies should test this concept more extensively, especially by determining parameters for a representative sample of the general population and by comparing performance with other approaches to value the SF-12. Copyright (c) 2005 John Wiley & Sons, Ltd. SN - 1057-9230 AD - Department of Health Economics, University of Ulm, Ulm, Germany. U2 - PMID: 16389653. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106356196&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105944278 T1 - Genetic counseling and management of newly diagnosed breast cancer patients at genetic risk for BRCA germline mutations...Breast J. 2004 Nov-Dec;10(6):475-80 AU - Silva E AU - Lynch H Y1 - 2006/05// N1 - Accession Number: 105944278. Language: English. Entry Date: 20080125. Revision Date: 20150711. Publication Type: Journal Article; commentary; letter; response. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Peer Reviewed; USA. NLM UID: 9505539. KW - Breast Neoplasms KW - Breast Neoplasms -- Therapy KW - Decision Trees KW - Genetic Counseling -- Methods KW - Breast Neoplasms -- Diagnosis KW - Female KW - Genes, BRCA KW - Genetic Screening -- Methods KW - Mutation KW - Proteins SP - 280 EP - 284 JO - Breast Journal JF - Breast Journal JA - BREAST J VL - 12 IS - 3 CY - Malden, Massachusetts PB - Wiley-Blackwell SN - 1075-122X U2 - PMID: 16684334. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105944278&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106454334 T1 - Cost-effectiveness of preventive strategies for women with a BRCA1 or a BRCA2 mutation. AU - Anderson K AU - Jacobson JS AU - Heitjan DF AU - Zivin JG AU - Hershman D AU - Neugut AI AU - Grann VR Y1 - 2006/03/21/ N1 - Accession Number: 106454334. Language: English. Entry Date: 20060609. Revision Date: 20150711. Publication Type: Journal Article; consumer/patient teaching materials; research; tables/charts. Journal Subset: Biomedical; Expert Peer Reviewed; Peer Reviewed; USA. Grant Information: American Cancer Society (RSGH-03-166-01-PBP), a K07 Award (CA-95597), and a K05 Award (CA89155) from the National Cancer Institute. NLM UID: 0372351. KW - Breast Neoplasms -- Familial and Genetic KW - Ovarian Neoplasms -- Familial and Genetic KW - Breast Neoplasms -- Prevention and Control KW - Ovarian Neoplasms -- Prevention and Control KW - Genes, BRCA KW - Computer Simulation KW - Mutation KW - Genetic Screening -- Economics KW - Patient Education KW - Cost Benefit Analysis KW - Funding Source KW - Human SP - 397 EP - 406 JO - Annals of Internal Medicine JF - Annals of Internal Medicine JA - ANN INTERN MED VL - 144 IS - 6 CY - Philadelphia, Pennsylvania PB - American College of Physicians AB - BACKGROUND: For BRCA1 or BRCA2 mutation carriers, decision analysis indicates that prophylactic surgery or chemoprevention leads to better survival than surveillance alone. OBJECTIVE: To evaluate the cost-effectiveness of the preventive strategies that are available to unaffected women carrying a single BRCA1 or BRCA2 mutation with high cancer penetrance. DESIGN: Markov modeling with Monte Carlo simulations and probabilistic sensitivity analyses. DATA SOURCES: Breast and ovarian cancer incidence and mortality rates, preference ratings, and costs derived from the literature; the Surveillance, Epidemiology, and End Results (SEER) Program; and the Health Care Financing Administration (now the Centers for Medicare & Medicaid Services). TARGET POPULATION: Unaffected carriers of a single BRCA1 or BRCA2 mutation 35 to 50 years of age. TIME HORIZON: Lifetime. PERSPECTIVE: Health policy, societal. INTERVENTIONS: Tamoxifen, oral contraceptives, bilateral salpingo-oophorectomy, mastectomy, both surgeries, or surveillance. OUTCOME MEASURES: Cost-effectiveness. RESULTS OF BASE-CASE ANALYSIS: For mutation carriers 35 years of age, both surgeries (prophylactic bilateral mastectomy and oophorectomy) had an incremental cost-effectiveness ratio over oophorectomy alone of 2352 dollars per life-year for BRCA1 and 100 dollars per life-year for BRCA2. With quality adjustment, oophorectomy dominated all other strategies for BRCA1 and had an incremental cost-effectiveness ratio of 2281 dollars per life-year for BRCA2. RESULTS OF SENSITIVITY ANALYSIS: Older age at intervention increased the cost-effectiveness of prophylactic mastectomy for BRCA1 mutation carriers to 73,755 dollars per life-year. Varying the penetrance, mortality rates, costs, discount rates, and preferences had minimal effects on outcomes. LIMITATIONS: Results are dependent on the accuracy of model assumptions. CONCLUSION: On the basis of this model, the most cost-effective strategies for BRCA mutation carriers, with and without quality adjustment, were oophorectomy alone and oophorectomy and mastectomy, respectively. SN - 0003-4819 AD - Herbert Irving Comprehensive Cancer Center U2 - PMID: 16549852. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106454334&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106170861 T1 - Individualized Risk Information System (IRIS): development of a decision support system for BRCA carriers with breast cancer...Presented abstracts from the Twenty-Fourth Annual Education Conference of the National Society of Genetic Counselors (Los Angeles, California, November 2005) AU - Culver J AU - Thornton A AU - Metcalfe K AU - Grant M AU - Narod S AU - Burke H AU - Weitzel J Y1 - 2006/02/02/ N1 - Accession Number: 106170861. Language: English. Entry Date: 20070817. Revision Date: 20150711. Publication Type: Journal Article; abstract. Journal Subset: Biomedical; Continental Europe; Europe; Peer Reviewed. NLM UID: 9206865. KW - Breast Neoplasms -- Familial and Genetic KW - Decision Support Systems, Clinical KW - Female KW - Genetic Counseling SP - 5 EP - 5 JO - Journal of Genetic Counseling JF - Journal of Genetic Counseling JA - J GENETIC COUNS VL - 15 IS - 1 CY - , PB - Springer Science & Business Media B.V. SN - 1059-7700 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106170861&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - THES ID - 109847304 T1 - Spirituality and the experience of being a member of a family with hereditary breast and ovarian cancer. AU - Tinley ST Y1 - 2006/01// N1 - Accession Number: 109847304. Language: English. Entry Date: 20071123. Revision Date: 20150923. Publication Type: Doctoral Dissertation; abstract; research. KW - Breast Neoplasms -- Familial and Genetic KW - Neoplastic Syndromes, Hereditary -- Psychosocial Factors KW - Ovarian Neoplasms -- Familial and Genetic KW - Heterozygote -- Psychosocial Factors KW - Decision Making KW - Family Relations KW - Female KW - Interviews KW - Narratives KW - Phenomenological Research KW - Spirituality KW - Support, Psychosocial KW - Thematic Analysis KW - Human SP - 119 p EP - 119 p JO - Spirituality & the Experience of Being a Member of a Family With Hereditary Breast & Ovarian Cancer JF - Spirituality & the Experience of Being a Member of a Family With Hereditary Breast & Ovarian Cancer PB - University of Utah AB - Most families with hereditary breast and ovarian cancer (HBOC) have a history of multiple cancer occurrences and possibly deaths during the young to middle adult years. There is a constant threat of that history being repeated in other family members. Despite the threats and occurrences of cancer, the women in these families often display remarkable resiliency, mutual support and family cohesiveness. Many attribute their strength and ability to cope with adversity to their spiritual beliefs. The purpose of this study was to identify the relationship between spirituality and the experiences of being part of a family with HBOC among BRCA1/2 mutation carriers. An examination of three philosophical approaches to the study of spirituality revealed interpretivism as the most appropriate paradigm in which to situate this study. Hermeneutic phenomenology provided the methodology and 16 women who are carriers of BRCA1/2 mutations were interviewed about their experiences and how they relate to their spirituality. The narratives from these women have presented, in the words of one participant, 'a mixed bag of experiences.' It was a mixed bag in the sense that their experiences were often unpredictable and beyond their control with contrasts of positives and negatives. The contrasting experiences included: family history as a welcome warning as opposed to a source of worries; models of strength versus the anguish of losses; a legacy of cancer forever lurking but life goes on; and mutual support versus isolation. The majority of the women identified a Christian perspective to their spirituality, but three did not identify any religious affiliation and two of the latter were uncertain about their belief in God. Yet there was a common theme in the reciprocal relationship between their experiences as members of families with HBOC and their spirituality. Their experiences influenced their spirituality and alternatively their spirituality influenced their interpretation of the experiences. Their experiences influenced their spirituality by: intensifying spiritual struggles; strengthening their spirituality, and providing models of spirituality. Their spirituality influenced their interpretation of their experiences by providing: sources of support; an aid to decision-making, and gifts and gratitude. SN - 9780542798702 AV - UMI Order AAI3226909 M1 - Ph.D. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109847304&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106021795 T1 - Individualized survival curves improve satisfaction with cancer risk management decisions in women with BRCA1/2 mutations. AU - Armstrong K AU - Weber B AU - Ubel PA AU - Peters N AU - Holmes J AU - Schwartz JS Y1 - 2005/12/20/ N1 - Accession Number: 106021795. Language: English. Entry Date: 20071207. Revision Date: 20150711. Publication Type: Journal Article; clinical trial; research. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 8309333. KW - Breast Neoplasms KW - Decision Support Systems, Clinical KW - Genes, BRCA KW - Patient Satisfaction KW - Adult KW - Anxiety KW - Breast Neoplasms -- Epidemiology KW - Breast Neoplasms -- Therapy KW - Decision Making KW - Double-Blind Studies KW - Female KW - Incidence KW - Middle Age KW - Prognosis KW - Risk Management KW - Survival Analysis KW - Human SP - 9319 EP - 9328 JO - Journal of Clinical Oncology JF - Journal of Clinical Oncology JA - J CLIN ONCOL VL - 23 IS - 36 CY - Alexandria, Virginia PB - American Society of Clinical Oncology AB - PURPOSE: Women with BRCA1/2 mutations are faced with complex decisions about breast and ovarian cancer risk management. This study was conducted to determine the effect of a tailored decision support system (DSS) that provides individualized survival and cancer incidence curves specific to expected outcomes of alternative management strategies. PATIENTS AND METHODS: This was a double-blind, randomized controlled trial of 32 women with BRCA1/2 mutations. Primary outcome measures were decision satisfaction, cancer anxiety, perceptions of cancer risk given alternative management strategies, and management decisions. RESULTS: Twenty-seven women completed a 6-week follow-up. Women in the intervention arm (n = 13) reported significantly higher decision satisfaction at follow-up than women in the control arm (n = 14; adjusted mean difference, 9.7; P < .0005). The effect of the DSS was greater among women with low cancer anxiety at baseline than women with high cancer anxiety at baseline (P = .01 for interaction). However, the DSS did not significantly alter cancer anxiety at follow-up, perceptions of cancer risk given alternative management strategies, or management decisions. CONCLUSION: The presentation of individualized survival and incidence curves for alternative management options improves satisfaction about cancer risk management decisions among women with BRCA1/2 mutations without increasing anxiety or changing management decisions. The benefit of the DSS is greatest among women with relatively low cancer-related anxiety at baseline. SN - 0732-183X AD - Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. karmstro@mail.med.upenn.edu U2 - PMID: 16361631. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106021795&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106414974 T1 - Informed consent for mammography screening: modelling the risks and benefits for American women. AU - Marshall T Y1 - 2005/12// N1 - Accession Number: 106414974. Language: English. Entry Date: 20070101. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Europe; Health Services Administration; Peer Reviewed; UK & Ireland. NLM UID: 9815926. KW - Breast Neoplasms -- Diagnosis KW - Consent KW - Mammography KW - Adult KW - Age Factors KW - Aged KW - Breast Neoplasms -- Mortality KW - False Positive Results KW - Female KW - Health Knowledge -- Evaluation KW - Middle Age KW - Relative Risk KW - Sensitivity and Specificity KW - Human SP - 295 EP - 305 JO - Health Expectations JF - Health Expectations JA - HEALTH EXPECTATIONS VL - 8 IS - 4 CY - Malden, Massachusetts PB - Wiley-Blackwell AB - INTRODUCTION: In order to facilitate informed decision making, women require information on the probabilities of different outcomes with mammography screening. This paper derives these probabilities for a US population and illustrates them visually in a readily understandable format. METHODS: Probabilities of the breast cancer mortality, all cause mortality and further investigation are derived from published data on mortality from breast cancer and published estimates of effectiveness using a life-table method. Probabilities are calculated of surviving to age 75 from age 40 with and without two-yearly mammography screening from age 40 and age 50. Probabilities are also calculated that a woman will be referred for further assessment or biopsy or die from breast cancer despite screening. To avoid being misled, these outcomes are presented in the form of a single decision aid illustrating the outcomes for 1000 women choosing each alternative: mammography screening or no mammography screening. RESULTS: Of 1000 women undergoing two-yearly mammography screening from age 40 an additional four (3.7 per 1000) will reach the age of 75; of the survivors 514 will be referred for further investigation and 138 will undergo biopsy. Of 1000 women screened from age 50 an additional three (3.3 per 1000) will reach age 75; of the survivors 408 will be referred for further investigation and 94 will undergo biopsy. Mammography from age 40 to 49 reduces mortality by 0.4 in 1000. This information is readily presented visually. CONCLUSIONS: It is possible to provide realistic estimates of the effects of mammography screening on mortality in a readily understandable format. Women require this information if they are to make informed choices about mammography screening. SN - 1369-6513 AD - Department of Public Health and Epidemiology, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; t.p.marshall@bham.ac.uk U2 - PMID: 16266417. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106414974&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106541081 T1 - Breast cancer decision analysis for hormonal therapy fills gap between trial data & clinical need. AU - Goodman A Y1 - 2005/07/11/2005 Jul 10 Supplement N1 - Accession Number: 106541081. Language: English. Entry Date: 20051118. Revision Date: 20150711. Publication Type: Journal Article. Supplement Title: 2005 Jul 10 Supplement. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 8100849. KW - Breast Neoplasms -- Drug Therapy KW - Decision Making KW - Hormone Therapy KW - Medical Practice, Evidence-Based KW - Female KW - Models, Theoretical SP - 10 EP - 10 JO - Oncology Times JF - Oncology Times JA - ONCOL TIMES CY - Baltimore, Maryland PB - Lippincott Williams & Wilkins SN - 0276-2234 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106541081&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106545417 T1 - Decision making and decision support for hereditary breast-ovarian cancer susceptibility. AU - Schwartz MD AU - Peshkin BN AU - Tercyak KP AU - Taylor KL AU - Valdimarsdottir H Y1 - 2005/07/02/Jul2005 Supplement N1 - Accession Number: 106545417. Language: English. Entry Date: 20051202. Revision Date: 20150711. Publication Type: Journal Article; review; tables/charts. Supplement Title: Jul2005 Supplement. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 8211523. KW - Breast Neoplasms -- Familial and Genetic KW - Decision Making, Patient KW - Disease Susceptibility KW - Genetic Counseling KW - Genetic Screening -- Psychosocial Factors KW - Ovarian Neoplasms -- Familial and Genetic KW - Affect KW - Decision Making, Clinical KW - Disease Management KW - Female KW - Literature Review KW - Mastectomy -- Utilization KW - Oophorectomy -- Utilization SP - S78 EP - 84 JO - Health Psychology JF - Health Psychology JA - HEALTH PSYCHOL VL - 24 CY - Washington, District of Columbia PB - American Psychological Association AB - Genetic testing for disease susceptibility has the potential to revolutionize health care by allowing for individually tailored disease prevention strategies. To achieve this promise, patients and physicians must use the information obtained through genetic testing to make medical decisions that are consistent with patient preferences and that lead to reduced disease morbidity and mortality. However, decisions associated with genetic testing can be complex. In this article, the authors review decision making associated with genetic testing and the medical management of hereditary breast-ovarian cancer susceptibility. They focus on decisions regarding BRCA1/2 testing and prophylactic surgery among BRCA1 and BRCA2 mutation carriers. They highlight the role of patient preferences and decision support in this population. The studies reviewed indicate that although patients' preferences do predict genetic testing and management decisions, other factors also influence their decision making. In particular, the authors discuss the role of anxiety and worry in relation to testing and surgery decisions. ((c) 2005 APA, all rights reserved). SN - 0278-6133 AD - Lombardi Comprehensive Cancer Canter, Cancer Prevention and Control, 2233 Wisconsin Avenue, Northwest, Suite 317, Washington, DC; schwartm@georgetown.edu U2 - PMID: 16045423. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106545417&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106503014 T1 - Decreased use of adjuvant breast cancer therapy in a randomized controlled trial of a decision aid with individualized risk information. AU - Peele PB AU - Siminoff LA AU - Xu Y AU - Ravdin PM Y1 - 2005/06// N1 - Accession Number: 106503014. Language: English. Entry Date: 20050819. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts; randomized controlled trial. Journal Subset: Biomedical; Peer Reviewed; USA. Grant Information: Provided in part by a grant from the National Cancer Institute (RO1-CA711040). NLM UID: 8109073. KW - Breast Neoplasms -- Therapy KW - Decision Making, Patient KW - Information Needs KW - Physicians -- Psychosocial Factors KW - Adult KW - Chi Square Test KW - Randomized Controlled Trials KW - Descriptive Statistics KW - Female KW - Funding Source KW - Logistic Regression KW - Male KW - Mann-Whitney U Test KW - Middle Age KW - Odds Ratio KW - P-Value KW - Socioeconomic Factors KW - Spearman's Rank Correlation Coefficient KW - Human SP - 301 EP - 307 JO - Medical Decision Making JF - Medical Decision Making JA - MED DECIS MAKING VL - 25 IS - 3 CY - Thousand Oaks, California PB - Sage Publications Inc. AB - OBJECTIVE: Oncology patients often seek involvement in their medical consultations. Such involvement is endorsed by most health care providers and mirrored in practice guidelines. However, oncologists exhibit great variation in how they provide patients with disease-relevant information, and many remain reluctant to do so at all. The authors examined the impact of a patient-specific decision aid on women's decisions about adjuvant therapy for breast cancer. METHOD: 386 women with breast cancer were randomized to receive either an informational pamphlet about adjuvant therapy (usual care) or a patient-specific, evidence-based decision aid about adjuvant therapy. The authors compared rates of adjuvant therapy between the groups controlling for age, education, marital status, race, tumor severity, and practice type of their physician (university-based or community-based). RESULTS: Among women with low tumor severity, only 58% (35/60) of women in the decision aid group chose adjuvant therapy, compared to 87% (33/38) of their counterparts in usual care (P<0.01). CONCLUSIONS: This study illustrates the important impact of medical decision aids on treatment choices, particularly for patients for whom treatment has little benefit. In the case of adjuvant therapy for breast cancer, providing individualized, evidence-based risk information for shared decision making resulted in fewer women with low tumor severity choosing adjuvant treatment. SN - 0272-989X AD - Department of Health Policy & Management, Graduate School of Public Health, University of Pittsburgh; peele@pitt.edu U2 - PMID: 15951457. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106503014&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106649225 T1 - Economic analysis of targeting chemotherapy using a 21-gene RT-PCR assay in lymph-node-negative, estrogen-receptor-positive, early-stage breast cancer. AU - Hornberger J AU - Cosler LE AU - Lyman GH Y1 - 2005/05//2005 May N1 - Accession Number: 106649225. Language: English. Entry Date: 20050617. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Health Services Administration; Peer Reviewed; USA. Grant Information: Sponsored in part by Genomic Health, Inc., Redwood City, CA. NLM UID: 9613960. KW - Breast Neoplasms -- Classification KW - Breast Neoplasms -- Drug Therapy KW - Chemotherapy, Cancer -- Economics KW - Neoplasm Staging KW - Confidence Intervals KW - Cost Benefit Analysis KW - Descriptive Statistics KW - Female KW - P-Value KW - Quality of Life KW - Funding Source KW - Human SP - 313 EP - 324 JO - American Journal of Managed Care JF - American Journal of Managed Care JA - AM J MANAGE CARE VL - 11 IS - 5 CY - Plainsboro, New Jersey PB - Intellisphere, LLC AB - Objective: To appraise the economics of a recurrence score (RS), based on an assay that predicts distant recurrence-free survival in lymph-node-negative (LN-), estrogen-receptor-positive (ER+) patients with early-stage breast cancer receiving tamoxifen.Study Design: Cost-utility analyses using a decision analytic model.Methods: Using a Markov model, we forecast overall survival, costs, and cost effectiveness of using the RS in patients classified as having low or high risk of distant recurrence based on National Comprehensive Cancer Network (NCCN) clinical guidelines. Data from a large multicenter clinical trial (NSABP B-14) were analyzed to derive risk classification based on guideline criteria and RS assignments. Efficacy of adjuvant chemotherapy (CT) on distant recurrence-free survival (DRFS) was based on published meta-analyses of CT trials. The analysis took a societal perspective, considering survival, quality of life, and relevant costs.Results: Fifty-three patients (8%) were classified as having low risk of distant recurrence by NCCN guidelines and the RS reclassified 15 of these patients (28%) to an intermediate/high-risk group. The remaining 615 patients (92%) were classified at high risk of distant recurrence by NCCN guidelines and the RS reclassified 300 of these patients (49%) to a low-risk group. Among a hypothetical cohort of 100 patients, RS is predicted on average to increase quality-adjusted survival by 8.6 years and reduce overall costs by $202 828. RS was cost saving in more than two-thirds of probabilistic simulations, with cost effectiveness most influenced by the propensity to administer CT based on RS results, and by the pro-portion of patients at low risk as defined by NCCN guidelines.Conclusions: The RS predicts more accurately than current guidelines recurrence risk in LN-, ER+ patients with early-stage breast cancer. If applied appropriately, the assay is predicted to increase quality-adjusted survival and save costs. SN - 1088-0224 AD - SPHERE Institute/Acumen, LLC, Burlingame, CA; jhornberger@acumen-llc.com U2 - PMID: 15898220. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106649225&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106502873 T1 - Facets and determinants of quality of life in patients with recurrent high grade glioma. AU - Giovagnoli AR AU - Silvani A AU - Colombo E AU - Boiardi A AU - Giovagnoli, A R AU - Silvani, A AU - Colombo, E AU - Boiardi, A Y1 - 2005/04// N1 - Accession Number: 106502873. Language: English. Entry Date: 20050819. Revision Date: 20171118. Publication Type: journal article; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. Instrumentation: State-Trait Anxiety Inventory (STAI) (Spielberger); Karnofsky Performance Status Scale (KPS); Raven's Coloured Progressive Matrices (RCPM); Functional Living Index-Cancer (FLIC); Self Rating Depression Scale (SRDS); Attentive Matrices (AM); Story Recall (SR); Trail Making Test (TMT A-B). NLM UID: 2985191R. KW - Brain Neoplasms -- Complications KW - Brain Neoplasms -- Psychosocial Factors KW - Cognition Disorders -- Etiology KW - Depression -- Etiology KW - Glioma -- Psychosocial Factors KW - Quality of Life KW - Activities of Daily Living KW - Adult KW - Analysis of Variance KW - Biopsy KW - Breast Neoplasms -- Therapy KW - Chi Square Test KW - Coefficient Alpha KW - Cognition Disorders -- Diagnosis KW - Depression -- Diagnosis KW - Descriptive Statistics KW - Factor Analysis KW - Female KW - Glioma -- Complications KW - Glioma -- Therapy KW - Internal Consistency KW - Karnofsky Performance Status KW - Kruskal-Wallis Test KW - Male KW - Mann-Whitney U Test KW - Middle Age KW - Nausea -- Etiology KW - Neoplasm Staging KW - Neuropsychological Tests KW - One-Way Analysis of Variance KW - P-Value KW - Pearson's Correlation Coefficient KW - Prospective Studies KW - Psychological Tests KW - Questionnaires KW - Retrospective Design KW - Scales KW - Self Report KW - Social Isolation -- Psychosocial Factors KW - State-Trait Anxiety Inventory KW - Step-Wise Multiple Regression KW - Visual Analog Scaling KW - Human SP - 562 EP - 568 JO - Journal of Neurology, Neurosurgery & Psychiatry JF - Journal of Neurology, Neurosurgery & Psychiatry JA - J NEUROL NEUROSURG PSYCHIATRY VL - 76 IS - 4 PB - BMJ Publishing Group AB - Objectives: To assess patients with recurrent high grade brain glioma with the aim of evaluating facets of quality of life (QOL) and their association with mood, cognition, and physical performance.Methods: Ninety four glioma patients (four groups with different duration of glioma recurrence) were compared with 24 patients with other chronic neurological diseases and 48 healthy subjects. The Functional Living Index-Cancer (FLIC) provided QOL self evaluations, and standardised scales and neuropsychological tests assessed physical performance, mood, and cognition.Results: In glioma patients, factor analysis of the FLIC items documented five domains: Psychological well being, Role/sociability, Inner experience of disease, Isolation/sharing, and Nausea. Higher FLIC total scores were related to better cognition, physical performances, and mood, and lower grading; poorer Psychological well being and worse Inner experience of disease to depressed mood; minor Role/sociability to worse cognitive and physical performances and higher grading; worse Nausea to longer disease duration. Compared with healthy subjects, all glioma groups were cognitively impaired and more anxious, and two groups with short duration of recurrence were also more depressed. Patients with chronic neurological diseases showed worse mood and cognitive abilities compared with healthy subjects, but performed attention tests better than glioma patients. Glioma and chronic disease patients showed similar FLIC scores and autonomy.Conclusions: These results show that QOL of recurrent high grade glioma patients is multifaceted and determined by multiple factors. Disease severity does not necessarily eliminate the possibility of expressing personal feelings and opinions which could provide criteria for clinical decision making and psychological support. SN - 0022-3050 AD - Department of Neurology and Neuropathology, Carlo Besta National Neurological Institute, Via Celoria 11, 20133 Milan, Italy AD - Department of Neurology and Neuropathology, Carlo Besta National Neurological Institute, Via Celoria 11, 20133 Milan, Italy; rgiovagnoli@istituto-besta.it U2 - PMID: 15774446. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106502873&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106417405 T1 - Physician/patient decision aids for adjuvant therapy. AU - Whelan TJ AU - Loprinzi C Y1 - 2005/03/10/ N1 - Accession Number: 106417405. Language: English. Entry Date: 20060331. Revision Date: 20150711. Publication Type: Journal Article; pictorial; review. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 8309333. KW - Decision Making, Patient KW - Breast Neoplasms -- Drug Therapy KW - Antineoplastic Agents -- Therapeutic Use KW - Chemotherapy, Adjuvant KW - Physician's Role KW - Patient Education -- Methods SP - 1627 EP - 1630 JO - Journal of Clinical Oncology JF - Journal of Clinical Oncology JA - J CLIN ONCOL VL - 23 IS - 8 CY - Alexandria, Virginia PB - American Society of Clinical Oncology SN - 0732-183X AD - Juravinski Cancer Centre, 699 Concession St, Room 3-62, Hamilton, Ontario, L8V 5C2; tim.whelan@hrcc.on.ca U2 - PMID: 15755969. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106417405&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106475555 T1 - What information do breast cancer screening programmes provide to Italian women? AU - Giordano L AU - Rowinski M AU - Gaudenzi G AU - Segnan N Y1 - 2005/02// N1 - Accession Number: 106475555. Language: English. Entry Date: 20050701. Revision Date: 20170831. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Europe; Peer Reviewed; Public Health; UK & Ireland. NLM UID: 9204966. KW - Breast Neoplasms -- Education KW - Information Needs KW - Information Resources -- Evaluation KW - Mammography -- Education KW - Access to Information KW - Aged KW - Descriptive Statistics KW - Female KW - Italy KW - Middle Age KW - Human SP - 66 EP - 69 JO - European Journal of Public Health JF - European Journal of Public Health JA - EUR J PUBLIC HEALTH VL - 15 IS - 1 PB - Oxford University Press / USA AB - BACKGROUNDS: The necessity for building transparent communications on screening, both on risks and benefits, is shared by different sides. There is a general agreement that women cannot express informed participation in a screening programme unless they are given sufficient and adequate information. In the screening context, invitation letters and leaflets often represent the principal source of information. METHODS: The invitation letters and leaflets used by 60 Italian breast cancer screening programmes were collected and evaluated through a score sheet developed to verify what kind of information is provided to women. RESULTS: Fifty-three programmes (88.3%) answered and 47 (78.3%) were included in the analysis because of completeness of the material. Nearly all the programmes provide satisfactory practical information and explanations about the test and the screening aims. Few programmes mention the possibility of some discomfort during the exam (34.0%), quality assessment and operator training (10.6%), double reading (6.4%), radiation risk (6.4%) and data confidentiality (6.4%). 68.1% provide information about recall but none describes what a further assessment involves. Epidemiological and numerical information are present only occasionally. CONCLUSION: Although satisfactorily disclosing some practical information, Italian invitation letters and leaflets remain inadequate in managing side effects and risks. If accurate information has the potential to enable women to make an informed choice, the information inviting them to perform screening test must be improved. Further researcher is needed to evaluate different decision aids to meet women's desires for balanced information. KEY POINTS: Women cannot express informed participation in a breast screening programme unless they are given balanced information both on benefits and adverse effects. Current information screening tools often omit relevent data, fail to give information about pros and cons and ignore uncertainties. Despite these considerations, how much information should be given and how this should be framed remains still to be defined. Further evalutions of different ways of presenting information and women's information needs are urgently required. SN - 1101-1262 AD - Unit of Epidemiology, CPO Piemonte, ASO San Giovanni Battista di Torino, Via S. Francesco da Paola 31, 10124 Torino, Italy; livia.giordano@cpo.it U2 - PMID: 15788806. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106475555&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106621977 T1 - Impact of computer-aided detection prompts on the sensitivity and specificity of screening mammography. AU - Taylor P AU - Champness J AU - Given-Wilson R AU - Johnston K AU - Potts H Y1 - 2005/01// N1 - Accession Number: 106621977. Language: English. Entry Date: 20060106. Revision Date: 20150711. Publication Type: Journal Article; equations & formulas; forms; glossary; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. NLM UID: 9706284. KW - Breast Neoplasms -- Diagnosis KW - Diagnosis, Computer Assisted -- Evaluation KW - Mammography KW - Confidence Intervals KW - Control (Research) KW - Cost Benefit Analysis KW - Experimental Studies KW - Radiologic Technologists KW - Radiologists KW - Sensitivity and Specificity KW - Human SP - iii EP - 58 JO - Health Technology Assessment JF - Health Technology Assessment JA - HEALTH TECHNOL ASSESS VL - 9 IS - 19 PB - NIHR Journals Library AB - Objectives: To determine the value of computer-aided detection (CAD) for breast cancer screening. Design: Two sets of mammograms with known outcomes were used in two studies. Participants in both studies read the films with and without the benefit of a computer aid. In both studies, the order of reading sessions was randomised separately for each reader. The first set of 180 films, used in study I , included 20 false-negative interval cancers and 40 screen-detected cancers. The second set of 120 films, used in study 2, was designed to be favourable to CAD: all 44 cancer cases had previously been missed by a film reader and cancers prompted by CAD were preferentially included.Setting: The studies were conducted at five UK screening centres between January 2001 and April 2003. Participants: Thirty radiologists, five breast clinicians and 15 radiographers participated.Interventions: All cases in the trial were digitised and analysed using the R2 IMAGE CHECKER version 2.2. Participants all received training on the use of CAD. In the intervention condition, participants interpreted cases with a prompt sheet on which regions of potential abnormality were indicated.Main outcome measures: The sensitivity and specificity of participants were measured in both intervention and control conditions.Results: No significant difference was found for readers' sensitivity or specificity between the prompted and unprompted conditions in study I [95% confidence index (CI) for sensitivity with and without CAD is 0.76 to 0.80, for specificity it is 0.81 to 0.86 without CAD and 0.81 to 0.87 with CAD]. No statistically significant difference was found between the sensitivity and specificity of different groups of film reader (95% CI for unprompted sensitivity of radiologists was 0.75 to 0.81, for radiographers it was 0.71 to 0.81, prompted sensitivity was 0.76 to 0.81 for radiologists and 0.69 to 0.79 for radiographers). Thirty-five readers participated in study 2. Sensitivity was improved in the prompted condition (0.81 from 0.78) but the difference was slightly below the threshold for statistical significance (95% CI for the difference -0.003 to 0.064). Specificity also improved (0.87 from 0.86); again, the difference was not significant at 0.05 (95% CI -0.003 to 0.034).A cost-effectiveness analysis showed that computer prompting increases cost.Conclusions: No significant improvement in film readers' sensitivity or specificity or gain in cost-effectiveness was established in either study. This may be due to the system's low specificity, its relatively poor sensitivity for subtle cancers or the fact the prompts cannot serve as aids to decision-making. Readers may have been better able to make use of the prompts after becoming more accustomed to working with them. Prompts may have an impact in routine use that is not detectable in an experimental setting. Although the case for CAD as an element of the NHS Breast Screening Programme is not made here, further research is required. Evaluations of new CAD tools in routine use are underway and their results should be given careful attention. Executive summary available for free by visiting the document URL listed with this record. SN - 1366-5278 AD - Centre for Health Informatics and Multiprofessional Education, Royal Free and University College Medical School, London, UK U2 - PMID: 15717938. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106621977&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106622086 T1 - Improving the referral process for familial breast cancer genetic counselling: findings of three randomised controlled trials of two interventions. AU - Wilson BJ AU - Torrance N AU - Mollison J AU - Wordsworth S AU - Gray JR AU - Haites NE AU - Grant A AU - Campbell MK AU - Miedyzbrodzka Z AU - Clarke A AU - Watson MS AU - Douglas A Y1 - 2005/01// N1 - Accession Number: 106622086. Language: English. Entry Date: 20060106. Revision Date: 20150711. Publication Type: Journal Article; questionnaire/scale; research; tables/charts; randomized controlled trial. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. Instrumentation: Short Form-36 Health Survey (SF-36); Hospital Anxiety and Depression Scale (HADS); Mental Health Role Emotional Domain; Spielberger State Trait Anxiety Inventory [short form]. NLM UID: 9706284. KW - Breast Neoplasms -- Familial and Genetic KW - Genetic Counseling KW - Nurse Counselors KW - Referral and Consultation KW - Adult KW - Anxiety KW - Randomized Controlled Trials KW - Costs and Cost Analysis KW - Female KW - Outpatients KW - Physicians, Family KW - Questionnaires KW - Random Assignment KW - Scotland KW - Short Form-36 Health Survey (SF-36) KW - State-Trait Anxiety Inventory KW - Wales KW - Human SP - iii EP - 126 JO - Health Technology Assessment JF - Health Technology Assessment JA - HEALTH TECHNOL ASSESS VL - 9 IS - 19 PB - NIHR Journals Library AB - Main outcome measures: In the software system trial, the primary outcome was GPs' confidence in their management of patients with concerns about family history of breast cancer. For the nurse counsellor trial, the primary outcome was patient anxiety, measured using standard scales.Results: In the software system trial, 57 practices (230 GPs) were randomised to the intervention group and 29 (116 GPs) to the control group. No statistically significant differences were detected in GPs' confidence or any other outcomes. Fewer than half of the intervention GPs were aware of the software, and only 22 reported using it in practice. The estimated total cost was pounds 3.12 per CD-ROM distributed (2001 prices). For the two arms of the nurse counsellor trial, 289 patients (193 intervention, 96 control) and 297 patients (197 intervention and 100 control) consented, were randomised, returned a baseline questionnaire and attended the clinic for trials 1 and 2 respectively. The analysis in both cases suggested equivalence in all anxiety scores, and no statistically significant differences were detected in other outcomes in either trial. A cost-minimisation analysis suggested that the cost per counselling episode was pounds 10.23 lower in intervention arm than in the control arm and pounds 10.89 higher in the intervention arm than in the control arm (2001 prices) for trials 1 and 2, respectively. Taking the trials together, the costs were sensitive to the grades of doctors and the time spent in consultant supervision of the nurse counsellor, but they were only slightly affected by the grade of nurse counsellor, the selected discount rate and the lifespan of equipment. Conclusions: Computer-based systems in the primary care intervention cannot be recommended for widespread use without further evaluation and testing in real practice settings. Genetic nurse counsellors may be a cost-effective alternative to assessment by doctors. This trial does not provide definitive evidence that the general policy of employing genetics nurse counsellors is sound, as it was based on only three individuals. Future evaluations of computer-based decision support systems for primary care must first address their efficacy under ideal conditions, identify barriers to the use of such systems in practice, and provide evidence of the impact of the policy of such systems in routine practice. The nurse counsellor trial should be replicated in other settings to provide reassurance of the generalisability of the intervention and other models of nurse-based assessment, such as in outreach clinics, should be developed and evaluated. The design of future evaluations of professional substitution should also address issues such as the effect of different levels of training and experience of nurse counsellors, and learning effects. Executive summary available for free by visiting the document URL listed with this record. SN - 1366-5278 AD - Department of Public Health, University of Aberdeen, UK U2 - PMID: 15694064. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106622086&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106562792 T1 - Advances in endocrine therapy for breast cancer: considering efficacy, safety, and quality of life. AU - Harwood KV Y1 - 2004/12// N1 - Accession Number: 106562792. Language: English. Entry Date: 20050114. Revision Date: 20150820. Publication Type: Journal Article; algorithm; CEU; exam questions; tables/charts. Journal Subset: Core Nursing; Double Blind Peer Reviewed; Nursing; Peer Reviewed; USA. NLM UID: 9705336. KW - Antineoplastic Agents, Hormonal -- Therapeutic Use KW - Breast Neoplasms -- Drug Therapy KW - Aromatase -- Antagonists and Inhibitors KW - Chemotherapy, Adjuvant KW - Decision Making, Clinical KW - Drug Administration -- Nursing KW - Education, Continuing (Credit) KW - Enzyme Inhibitors -- Adverse Effects KW - Enzyme Inhibitors -- Therapeutic Use KW - Estrogen Antagonists -- Therapeutic Use KW - Female KW - Neoplasm Metastasis -- Drug Therapy KW - Neoplasm Recurrence, Local -- Drug Therapy KW - Progestational Hormones -- Therapeutic Use KW - Quality of Life KW - Selective Estrogen Receptor Modulators -- Therapeutic Use SP - 629 EP - 640 JO - Clinical Journal of Oncology Nursing JF - Clinical Journal of Oncology Nursing JA - CLIN J ONCOL NURS VL - 8 IS - 6 CY - Pittsburgh, Pennsylvania PB - Oncology Nursing Society AB - Breast cancer is the most common cancer found in women in the United States. Endocrine therapy is the standard of care for most women with hormone receptor-positive tumors in adjuvant and metastatic settings. The selective estrogen response modifier tamoxifen has been the standard treatment for postmenopausal patients for many years. Numerous new endocrine therapy agents provide women with novel treatment options, including the non steroidal aromatase inhibitors anastrozole and letrozole, the steroidal aromatase inhibitor exemestane, and the estrogen receptor antagonist fulvestrant. Clinical trials have begun to define the role of these agents and their unique side-effect profiles. Nurses are vital in supporting patients in the decision-making process, managing side effects of treatment, and making observations to enhance understanding of the patient experience with new treatments. This article will assist nurses in educating patients about endocrine therapy options and their associated potential short- and long-term side effects, as well as treatment demands. SN - 1092-1095 U2 - PMID: 15637958. DO - 10.1188/04.CJON.629-637 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106562792&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106083207 T1 - Surgical treatment planning in newly diagnosed breast cancer patients at high risk forbrca-1orbrca-2mutation. AU - Chung MA AU - Cady B Y1 - 2004/11//Nov/Dec2004 N1 - Accession Number: 106083207. Language: English. Entry Date: 20081219. Revision Date: 20150711. Publication Type: Journal Article; editorial. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Peer Reviewed; USA. NLM UID: 9505539. KW - Breast Neoplasms -- Surgery KW - Breast Neoplasms KW - Decision Support Techniques KW - Mastectomy -- Methods KW - Breast Neoplasms -- Diagnosis KW - Disease Susceptibility KW - Female KW - Genes, BRCA KW - Mutation SP - 473 EP - 474 JO - Breast Journal JF - Breast Journal JA - BREAST J VL - 10 IS - 6 CY - Malden, Massachusetts PB - Wiley-Blackwell SN - 1075-122X U2 - PMID: 15569200. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106083207&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106083216 T1 - Multidisciplinary breast unit: the activity of the past 15 years. AU - Ranieri E AU - Caprio G AU - Civitelli L AU - Barberi S AU - Ceccarelli F AU - Virno F Y1 - 2004/11//Nov/Dec2004 N1 - Accession Number: 106083216. Language: English. Entry Date: 20081219. Revision Date: 20150711. Publication Type: Journal Article; letter. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Peer Reviewed; USA. NLM UID: 9505539. KW - Breast Neoplasms -- Diagnosis KW - Breast Neoplasms -- Epidemiology KW - Decision Support Techniques KW - Multidisciplinary Care Team -- Administration KW - Adult KW - Breast Neoplasms -- Etiology KW - Female KW - Italy KW - Middle Age SP - 554 EP - 557 JO - Breast Journal JF - Breast Journal JA - BREAST J VL - 10 IS - 6 CY - Malden, Massachusetts PB - Wiley-Blackwell SN - 1075-122X U2 - PMID: 15569220. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106083216&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106636053 T1 - A method for making estimates of the benefit of the late use of letrozole in patients completing 5 years of tamoxifen. AU - Ravdin PM AU - Davis GJ AU - Ravdin, Peter M AU - Davis, Gregory J Y1 - 2004/10//2004 Oct N1 - Accession Number: 106636053. Language: English. Entry Date: 20050520. Revision Date: 20171115. Publication Type: journal article; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 100898731. KW - Breast Neoplasms -- Drug Therapy KW - Tamoxifen -- Therapeutic Use KW - Chemotherapy, Adjuvant KW - Cost Benefit Analysis KW - Female KW - Recurrence -- Risk Factors KW - Risk Assessment KW - Texas KW - Time Factors KW - Human SP - 313 EP - 316 JO - Clinical Breast Cancer JF - Clinical Breast Cancer JA - CLIN BREAST CANCER VL - 5 IS - 4 CY - New York, New York PB - Elsevier B.V. AB - This article discusses the rationale for 2 methods of making estimates of the benefit of letrozole as extended adjuvant hormonal therapy after 5 years of tamoxifen. It uses information from the Overview metaanalyses to develop general rules for making estimates of remaining risk of relapse for women completing 5 years of adjuvant tamoxifen without relapse. The first derived method shows that the expected benefit for such a woman is approximately one tenth of her risk of relapse in years 0-10 if untreated. The second method uses a modification of Adjuvant!, a decision support tool, and makes similar estimates. The decision tool supplies needed estimates of initial risk and allows adjustment for competing mortality. Uncertainties involved in making these estimates are also discussed. SN - 1526-8209 AD - Division of Oncology, University of Texas Health Sciences Center, San Antonio, USA AD - Division of Oncology, University of Texas Health Sciences Center, San Antonio; pmravdin@aol.com U2 - PMID: 15507180. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106636053&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106674171 T1 - Research. Computers aid genetic decisions. Y1 - 2004/09// N1 - Accession Number: 106674171. Language: English. Entry Date: 20050425. Revision Date: 20150819. Publication Type: Journal Article; brief item. Journal Subset: Australia & New Zealand; Core Nursing; Nursing. NLM UID: 9317904. KW - Breast Neoplasms -- Education KW - Computers and Computerization -- Utilization KW - Patient Education KW - Decision Making, Patient KW - Female KW - Genetic Counseling SP - 29 EP - 29 JO - Australian Nursing Journal JF - Australian Nursing Journal JA - AUST NURS J VL - 12 IS - 3 CY - Melbourne, PB - Australian Nursing & Midwifery Federation SN - 1320-3185 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106674171&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106515206 T1 - Randomized trial of a shared decision-making intervention consisting of trade-offs and individualized treatment information for BRCA1/2 mutation carriers. AU - van Roosmalen MS AU - Stalmeier PFM AU - Verhoef LCG AU - Hoekstra-Weebers JEH AU - Oosterwijk JC AU - Hoogerbrugge N AU - Moog U AU - van Daal WAJ Y1 - 2004/08/15/ N1 - Accession Number: 106515206. Language: English. Entry Date: 20050916. Revision Date: 20150711. Publication Type: Journal Article; clinical trial; research; tables/charts. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Grant Information: Dutch Cancer Society (grant no. 98-1585), Amsterdam, the Netherlands. NLM UID: 8309333. KW - Breast Neoplasms -- Therapy KW - Decision Making, Patient KW - Oncogenes KW - Decision Making, Clinical KW - Breast Neoplasms -- Familial and Genetic KW - Disease Susceptibility KW - Funding Source KW - Clinical Trials KW - Chi Square Test KW - Human SP - 3293 EP - 3301 JO - Journal of Clinical Oncology JF - Journal of Clinical Oncology JA - J CLIN ONCOL VL - 22 IS - 16 CY - Alexandria, Virginia PB - American Society of Clinical Oncology AB - PURPOSE: To evaluate a shared decision-making intervention (SDMI) for BRCA1/2 mutation carriers who have to make a choice between screening and prophylactic surgery for breasts and/or ovaries. PATIENTS AND METHODS: The SDMI consisted of two value assessment sessions, using the time trade-off method, followed by individualized treatment information based on (quality-adjusted) life expectancy. After the baseline assessment (2 weeks after a positive DNA test result), women were randomly assigned to the SDMI group (n = 44), receiving the SDMI 2 months after the test result, or to the control group (n = 44). The short- and long-term effects, 3 and 9 months after the test result, were assessed using questionnaires. Data were collected on well-being, treatment choice, and decision-related outcomes. RESULTS: In the short term, the SDMI had no effect. In the long term, with respect to well-being, patients in the SDMI group had less intrusive thoughts (P =.05) and better general health (P =.01) and tended to be less depressed (P =.07). With respect to decision-related outcomes for the breasts, the SDMI group held stronger preferences (P =.02) and agreed more strongly to having weighed the pros and cons (P =.01). No effect was found on treatment choice. In the long term, interaction effects between the SDMI and cancer history were found. The SDMI showed an overall beneficial effect for unaffected women, whereas affected women tended to experience detrimental effects. CONCLUSION: We conclude that the SDMI improved decision making in unaffected BRCA1/2 mutation carriers. Supporting decision making in a systematic way using trade-offs is beneficial for these women. SN - 0732-183X AD - Department of Radiotherapy, Department of Human Genetics and Hereditary Cancer Clinic, University Medical Center Nijmegen, PO Box 9101, 6500 HB Nijmegen, the Netherlands; m.vanroosmalen@rther.umcn.nl U2 - PMID: 15310772. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106515206&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 13926260 T1 - Effect of a decision aid on knowledge and treatment decision making for breast cancer surgery: a randomized trial. AU - Whelan, Timothy AU - Levine, Mark AU - Willan, Andrew AU - Gafni, Amiram AU - Sanders, Ken AU - Mirsky, Doug AU - Chambers, Shelley AU - O'Brien, Mary Ann AU - Reid, Susan AU - Dubois, Sacha Y1 - 2004/07/28/ N1 - Accession Number: 13926260. Language: English. Entry Date: 20161112. Revision Date: 20161112. Publication Type: journal article. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Instrumentation: Clinical Decision Making in Nursing Scale (CDMNS) (Jenkins); General Health Questionnaire (GHQ); Impact of Events Scale (IES); Booklet Category Test. NLM UID: 7501160. KW - Mastectomy KW - Breast Neoplasms -- Surgery KW - Decision Support Techniques KW - Lumpectomy KW - Physician-Patient Relations KW - Middle Age KW - Decision Making KW - Patient Education KW - Human KW - Female KW - Consumer Participation KW - Referral and Consultation KW - Attitude to Health KW - Patient Satisfaction KW - Surgery, Operative KW - Clinical Trials KW - Validation Studies KW - Comparative Studies KW - Evaluation Research KW - Multicenter Studies KW - Randomized Controlled Trials KW - Impact of Events Scale KW - Questionnaires KW - Scales SP - 435 EP - 441 JO - JAMA: Journal of the American Medical Association JF - JAMA: Journal of the American Medical Association JA - JAMA VL - 292 IS - 4 CY - Chicago, Illinois PB - American Medical Association AB - Context: The long-term results of randomized trials have demonstrated equivalent survival rates for mastectomy and breast-conserving therapy for the treatment of early stage breast cancer. Consequently, the choice of treatment should be based on a patient's preferences.Objective: To evaluate the impact of a decision aid regarding the different surgical treatment options on patient decision making.Design and Setting: A cluster randomized trial for which general surgeons in the communities of central-west, and eastern Ontario, Canada, were randomly assigned to use the decision aid or not in the surgical consultation. Patients received the decision aid or not based on the surgeon seen.Participants: Twenty surgeons participated in the study. Of the 208 eligible women with newly diagnosed clinical stage I or II breast cancer seen by study surgeons, 201 agreed to be evaluated: 94 were assigned to the decision board and 107 to usual practice. Patients were recruited from November 1999 to April 2002.Intervention: The decision board is a decision aid designed to help physicians inform their patients about different treatment options and to enable patients to express a preference for treatment.Main Outcome Measures: Patient knowledge about the surgical treatment of breast cancer; decisional conflict; satisfaction with decision making; and the treatment decision following the consultation.Results: Patients in the decision board group had higher knowledge scores about their treatment options (66.9 vs 58.7; P<.001), had less decisional conflict (1.40 vs 1.62, P =.02), and were more satisfied with decision making (4.50 vs 4.32, P =.05) following the consultation. Patients who used the decision board were more likely to choose BCT (94% vs 76%, P =.03).Conclusions: The decision board was helpful in improving communication and enabling women to make a choice regarding treatment. Such instruments should be considered by surgeons when communicating the different surgical options to women with breast cancer. SN - 0098-7484 AD - Department of Medicine, McMaster University AD - Department of Clinical Epidemiology and Biostatistics, McMaster University AD - Juravinski Cancer Centre, Hamilton AD - Department of Surgery, McMaster University, Canada AD - Hamilton Health Sciences, Hamilton AD - Queensway-Carleton Hospital, Ottawa, Ontario, Canada U2 - PMID: 15280341. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=13926260&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 13926259 T1 - Effect of a computer-based decision aid on knowledge, perceptions, and intentions about genetic testing for breast cancer susceptibility: a randomized controlled trial. AU - Green, Michael J. AU - Peterson, Susan K. AU - Baker, Maria Wagner AU - Harper, Gregory R. AU - Friedman, Lois C. AU - Rubinstein, Wendy S. AU - Mauger, David T. Y1 - 2004/07/28/ N1 - Accession Number: 13926259. Language: English. Entry Date: 20161112. Revision Date: 20161114. Publication Type: journal article. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Instrumentation: Clinical Decision Making in Nursing Scale (CDMNS) (Jenkins); Personal Resource Questionnaire (PRQ). Grant Information: R21 NR008539/NR/NINR NIH HHS/United States. NLM UID: 7501160. KW - Decision Making, Computer Assisted KW - Genetic Screening KW - Breast Neoplasms KW - Relative Risk KW - Mutation KW - Middle Age KW - Genetic Counseling KW - Patient Education KW - Genes, BRCA KW - Patient Satisfaction KW - Attitude to Health KW - Consumer Participation KW - Human KW - Female KW - Decision Support Techniques KW - Aged KW - Adult KW - Clinical Trials KW - Validation Studies KW - Comparative Studies KW - Evaluation Research KW - Multicenter Studies KW - Randomized Controlled Trials KW - Personal Resource Questionnaire KW - Scales SP - 442 EP - 452 JO - JAMA: Journal of the American Medical Association JF - JAMA: Journal of the American Medical Association JA - JAMA VL - 292 IS - 4 CY - Chicago, Illinois PB - American Medical Association AB - Context: As the availability of and demand for genetic testing for hereditary cancers increases in primary care and other clinical settings, alternative or adjunct educational methods to traditional genetic counseling will be needed.Objective: To compare the effectiveness of a computer-based decision aid with standard genetic counseling for educating women about BRCA1 and BRCA2 genetic testing.Design: Randomized controlled trial conducted from May 2000 to September 2002.Setting and Participants: Outpatient clinics offering cancer genetic counseling at 6 US medical centers enrolled 211 women with personal or family histories of breast cancer.Interventions: Standard one-on-one genetic counseling (n = 105) or education by a computer program followed by genetic counseling (n = 106).Main Outcome Measures: Participants' knowledge, risk perception, intention to undergo genetic testing, decisional conflict, satisfaction with decision, anxiety, and satisfaction with the intervention. Counselor group measures were administered at baseline and after counseling. Computer group measures were administered at baseline, after computer use, and after counseling. Testing decisions were assessed at 1 and 6 months. Outcomes were analyzed by high vs low risk of carrying a BRCA1 or BRCA2 mutation.Results: Both groups had comparable demographics, prior computer experience, medical literacy, and baseline knowledge of breast cancer and genetic testing, and both counseling and computer use were rated highly. Knowledge scores increased in both groups (P<.001) regardless of risk status, and change in knowledge was greater in the computer group compared with the counselor group (P =.03) among women at low risk of carrying a mutation. Perception of absolute risk of breast cancer decreased significantly after either intervention among all participants. Intention to undergo testing decreased significantly after either intervention among low-risk but not high-risk women. The counselor group had lower mean scores on a decisional conflict scale (P =.04) and, in low-risk women, higher mean scores on a satisfaction-with-decision scale (P =.001). Mean state anxiety scores were reduced by counseling but were within normal ranges for both groups at baseline and after either intervention, regardless of risk status.Conclusions: An interactive computer program was more effective than standard genetic counseling for increasing knowledge of breast cancer and genetic testing among women at low risk of carrying a BRCA1 or BRCA2 mutation. However, genetic counseling was more effective than the computer at reducing women's anxiety and facilitating more accurate risk perceptions. These results suggest that this computer program has the potential to stand alone as an educational intervention for low-risk women but should be used as a supplement to genetic counseling for those at high risk. SN - 0098-7484 AD - Penn State College of Medicine, Hershey, PA, USA AD - University of Texas M. D. Anderson Cancer Center, Houston, Texas AD - Penn State Cancer Institute, the Milton S. Hershey Medical Center, Hershey, PA AD - Penn State Cancer Institute, Lehigh Valley Hospital, Allentown, Pa AD - Baylor College of Medicine, Houston, Tex AD - Evanston Northwestern Healthcare, Evanston, Illinois U2 - PMID: 15280342. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=13926259&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - GEN ID - 13926240 T1 - Decision aids from genetics to treatment of breast cancer: long-term clinical utility or temporary solution? AU - Eng, Charis AU - Iglehart, Dirk Y1 - 2004/07/28/ N1 - Accession Number: 13926240. Language: English. Entry Date: 20161112. Revision Date: 20161112. Publication Type: commentary. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Instrumentation: Clinical Decision Making in Nursing Scale (CDMNS) (Jenkins). NLM UID: 7501160. KW - Breast Neoplasms KW - Breast Neoplasms -- Surgery KW - Patient Education KW - Decision Support Techniques KW - Genetic Screening KW - Decision Making, Computer Assisted KW - Consumer Participation KW - Female KW - Mastectomy KW - Human KW - Validation Studies KW - Comparative Studies KW - Evaluation Research KW - Multicenter Studies KW - Scales SP - 496 EP - 498 JO - JAMA: Journal of the American Medical Association JF - JAMA: Journal of the American Medical Association JA - JAMA VL - 292 IS - 4 CY - Chicago, Illinois PB - American Medical Association AB - Discusses decision aids from genetics to the treatment of breast cancer. Results of a randomized controlled trial evaluating the efficacy of face-to-face genetic education or education by a computer program; Decision aids, which are only useful if they reflect current and changing information and clinical practice. SN - 0098-7484 AD - Clinical Cancer Genetics Program, Human Cancer Genetics Program, Comprehensive Cancer Center, Division of Human Genetics, Department of Internal Medicine, Ohio State University, Columbus (Dr Eng); and Cancer Research UK Human Cancer Genetics Research Group, University of Cambridge, Cambridge, England (Dr Eng); Department of Cancer Biology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Department of Surgery, Harvard Medical School, Boston, Mass (Dr Iglehart). U2 - PMID: 15280348. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=13926240&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106556775 T1 - Breast cancer treatment in older women: impact of the patient-physician interaction. AU - Maly RC AU - Leake B AU - Silliman RA Y1 - 2004/07// N1 - Accession Number: 106556775. Language: English. Entry Date: 20050712. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. Instrumentation: Lubben Social Network Scale; Interactive Informational Support Scale; Tangible Informational Support Index; Participatory Decision Making Style Scale; Perceived Efficacy in Patient-Physician Interactions (PEPPI) Questionnaire; Charlson Comorbidity Index [adapted]. Grant Information: California Breast Cancer Research Program of the University of California, Grant 4PB-061, and the Robert Wood Johnson Foundation Generalist Physician Faculty Scholars Program, Grant 036833. NLM UID: 7503062. KW - Breast Neoplasms -- Surgery -- In Middle Age KW - Breast Neoplasms -- Surgery -- In Old Age KW - Cancer Patients -- Psychosocial Factors KW - Decision Making, Clinical KW - Decision Making, Patient KW - Physician-Patient Relations KW - Self-Efficacy KW - Support, Psychosocial -- Evaluation KW - Surgeons -- Psychosocial Factors KW - Age Factors KW - Aged KW - Aged, 80 and Over KW - California KW - Coefficient Alpha KW - Confidence Intervals KW - Cross Sectional Studies KW - Ethnic Groups KW - Factor Analysis KW - Female KW - Funding Source KW - Health Knowledge KW - Information Needs KW - Information Resources KW - Interviews KW - Logistic Regression KW - Middle Age KW - Odds Ratio KW - Questionnaires KW - Race Factors KW - Scales KW - Summated Rating Scaling KW - Surveys KW - Telephone KW - Treatment Delay KW - World Wide Web KW - Human SP - 1138 EP - 1145 JO - Journal of the American Geriatrics Society JF - Journal of the American Geriatrics Society JA - J AM GERIATR SOC VL - 52 IS - 7 CY - Malden, Massachusetts PB - Wiley-Blackwell AB - Objectives: To assess the impact of the patient-physician interaction on breast cancer care in older women. Design: Cross-sectional survey. Setting: Los Angeles County, California. Participants: Two hundred twenty-two consecutively identified breast cancer patients aged 55 and older who were within 6 months of breast cancer diagnosis and/or 1 month posttreatment. Measurements: Dependent variables were patient breast cancer knowledge, treatment delay, and receipt of breast-conserving surgery (BCS). Key independent variables were five dimensions of the patient-physician interaction by patient report, including physician provision of tangible and interactive informational support, physician provision of emotional support, physician participatory decision-making style, and patient perceived self-efficacy in the patient-physician interaction. Age and ethnicity were additional important independent variables. Results: In multiple logistic regression models, only physician interactive informational support had significant relationships with all three dependent variables, controlling for a wide range of patient sociodemographic and case-mix characteristics, visit length, number of physicians seen, social support, and physician sociodemographic and practice characteristics. Specifically, informational support positively predicted patient breast cancer knowledge (adjusted odds ratio (AOR)=1.18, 95% confidence interval (CI)=1.00-1.38), negatively predicted treatment delays (AOR=0.80, 95% CI=0.67-0.94), and positively predicted receipt of BCS (AOR=1.29, 95% CI=1.07-1.56). Age and ethnicity were not significant predictors in these models. Conclusion: One specific domain of the patient-physician interaction, interactive informational support, may provide an avenue to ensure adequate breast cancer knowledge for patient treatment decision-making, decrease treatment delay, and increase rates of BCS for older breast cancer patients, thereby potentially mitigating known healthcare disparities in this vulnerable population of breast cancer patients. SN - 0002-8614 AD - Department of Family Medicine, David Geffen School of Medicine at UCLA, Box 951683, 50-071 CHS, Los Angeles, CA 90095; rmaly@mednet.ucla.edu U2 - PMID: 15209652. DO - 10.1111/j.1532-5415.2004.52312.x UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106556775&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106486332 T1 - Impact of BRCA1/BRCA2 counseling and testing on newly diagnosed breast cancer patients. AU - Schwartz MD AU - Lerman C AU - Brogan B AU - Peshkin BN AU - Halbert CH AU - DeMarco T AU - Lawrence W AU - Main D AU - Finch C AU - Magnant C AU - Pennanen M AU - Tsangaris T AU - Willey S AU - Isaacs C Y1 - 2004/05/15/ N1 - Accession Number: 106486332. Language: English. Entry Date: 20050715. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Commentary: Daly MB. Tailoring breast cancer treatment to genetic status: the challenges ahead. (J CLIN ONCOL) 5/15/2004; 22 (10): 1776-1777. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Instrumentation: State-Trait Anxiety Inventory (STAI) (Spielberger); Impact of Events Scale (IES); Functional Assessment of Cancer Therapy-General questionnaire. NLM UID: 8309333. KW - Breast Neoplasms -- Familial and Genetic KW - Genetic Screening KW - Decision Making, Clinical KW - Decision Making, Patient KW - Mastectomy -- Methods KW - Breast Neoplasms -- Psychosocial Factors KW - Mutation KW - Clinical Assessment Tools KW - Psychological Tests KW - Impact of Events Scale KW - State-Trait Anxiety Inventory KW - Breast Neoplasms -- Pathology KW - Genetic Counseling KW - Genes KW - Breast Neoplasms -- Surgery KW - Prospective Studies KW - Chi Square Test KW - Coefficient Alpha KW - Descriptive Statistics KW - T-Tests KW - Multiple Logistic Regression KW - Adult KW - Female KW - Funding Source KW - Human SP - 1823 EP - 1829 JO - Journal of Clinical Oncology JF - Journal of Clinical Oncology JA - J CLIN ONCOL VL - 22 IS - 10 CY - Alexandria, Virginia PB - American Society of Clinical Oncology AB - PURPOSE: Approximately 5% to 10% of newly diagnosed breast cancer patients carry a BRCA1 or BRCA2 mutation. Given these patients' high risk for contralateral breast cancer, bilateral mastectomy is increasingly considered a treatment option for newly diagnosed BRCA1/2 carriers. In the present study, we prospectively evaluated the impact on surgical decision-making of pretreatment genetic counseling and BRCA1/BRCA2 testing among breast cancer patients at high-risk for carrying a mutation.PATIENTS AND METHODS: Participants were 194 newly diagnosed breast cancer patients who had not yet received definitive surgical treatment and who had at least a 10% prior probability of carrying a BRCA1/2 mutation. Participants were offered free genetic counseling and rapid BRCA1/2 testing. Primary analyses focused on the impact of BRCA1/2 test result on subsequent breast cancer surgical treatment.RESULTS: Forty-eight percent of patients who were found to carry a BRCA1/2 mutation chose bilateral mastectomy as their definitive breast cancer surgery. In contrast, 24% of patients in whom no mutation was detected and 4% of test decliners opted for bilateral mastectomy. Additional predictors of bilateral mastectomy included patients' self-reports of physician recommendations for BRCA1/2 testing and bilateral mastectomy.CONCLUSION: This study highlights patient interest in and the technical feasibility of offering presurgery BRCA1/2 testing to high-risk patients. Most importantly, these results demonstrate that BRCA1/2 test results significantly affect patients' surgical decision-making. The availability of genetic counseling and testing could serve as a valuable aid to patient decision-making for newly diagnosed breast cancer patients at high-risk for carrying a mutation. SN - 0732-183X AD - Georgetown University School of Medicine, Lombardi Comprehensive Cancer Center, Cancer Control, 2233 Wisconsin Ave, NW, Suite 317, Washington, DC 20007; schwartm@georgetown.edu U2 - PMID: 15067026. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106486332&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106579218 T1 - Hormone replacement therapy and life expectancy after prophylactic oophorectomy in women with BRCA1/2 mutations: a decision analysis. AU - Armstrong K AU - Schwartz JS AU - Randall T AU - Rubin SC AU - Weber B Y1 - 2004/03/15/ N1 - Accession Number: 106579218. Language: English. Entry Date: 20050211. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Commentary: Garber JE, Hartman A. Prophylactic oophorectomy and hormone replacement therapy: protection at what price? (J CLIN ONCOL) 3/15/2004; 22 (6): 978-980. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 8309333. KW - Hormone Replacement Therapy -- Adverse Effects KW - Ovarian Neoplasms -- Prevention and Control KW - Decision Making, Clinical KW - Oophorectomy KW - Mutation KW - Genes KW - Life Expectancy KW - Ovarian Neoplasms -- Familial and Genetic KW - Estrogens -- Adverse Effects KW - Disease Susceptibility KW - Postoperative Care KW - Confidence Intervals KW - Human SP - 1045 EP - 1054 JO - Journal of Clinical Oncology JF - Journal of Clinical Oncology JA - J CLIN ONCOL VL - 22 IS - 6 CY - Alexandria, Virginia PB - American Society of Clinical Oncology AB - PURPOSE: The decision about prophylactic oophorectomy is difficult for many premenopausal women with BRCA1/2 mutations because of concerns and controversy about the use of hormone replacement therapy (HRT) after oophorectomy. PATIENTS AND METHODS: A Markov decision analytic model used the most current epidemiologic data to assess the expected outcomes of prophylactic oophorectomy with or without HRT (to age 50 years or for life) in cohorts of women with BRCA1/2 mutations. Sensitivity analyses were conducted to assess the impact of alternative assumptions about effects of HRT, effects of prophylactic oophorectomy, and risks of cancer associated with BRCA1/2 mutations. RESULTS: In our model, prophylactic oophorectomy lengthened life expectancy in women with BRCA1/2 mutations, irrespective of whether HRT was used after oophorectomy. This gain ranged from 3.34 to 4.65 years, depending on age at oophorectomy. Use of HRT after oophorectomy was associated with relatively small changes in life expectancy (+0.17 to -0.34 years) when HRT was stopped at age 50, but larger decrements in life expectancy if HRT was continued for life (-0.79 to -1.09 years). HRT was associated with a gain in life expectancy of between 0.39 and 0.79 years for mutation carriers undergoing both prophylactic mastectomy and oophorectomy. CONCLUSION: On the basis of the results of this decision analysis, we recommend that women with BRCA1/2 mutations undergo prophylactic oophorectomy after completion of childbearing, decide about short-term HRT after oophorectomy based largely on quality-of-life issues rather than life expectancy, and, if using HRT, consider discontinuing treatment at the time of expected natural menopause, approximately age 50 years. SN - 0732-183X AD - University of Pennsylvania, 423 Guardian Dr, 1204 Blockley Hall, Philadelphia, PA 19104-6021; karmstro@mail.med.upenn.edu U2 - PMID: 14981106. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106579218&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106678757 T1 - Benefits and harms associated with hormone replacement therapy: clinical decision analysis. AU - Minelli C AU - Abrams KR AU - Sutton AJ AU - Cooper NJ Y1 - 2004/02/14/ N1 - Accession Number: 106678757. Language: English. Entry Date: 20041210. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. Grant Information: Schering Health Care. NLM UID: 101090866. KW - Decision Making, Clinical KW - Hormone Replacement Therapy KW - Hormone Replacement Therapy -- Adverse Effects KW - Aged KW - Breast Neoplasms -- Risk Factors KW - Confidence Intervals KW - Female KW - Funding Source KW - Middle Age KW - Models, Statistical KW - Perimenopausal Symptoms -- Prevention and Control KW - Quality of Life KW - Relative Risk KW - Women's Health KW - Human SP - 371 EP - 375 JO - BMJ: British Medical Journal (International Edition) JF - BMJ: British Medical Journal (International Edition) JA - BMJ VL - 328 IS - 7436 PB - BMJ Publishing Group SN - 0959-8146 AD - Centre for Biostatistics and Genetic Epidemiology, Dept of Health Sciences, University of Leicester, Leicester LE1 6TP, UK U2 - PMID: 14962874. DO - 10.1136/bmj.328.7436.371 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106678757&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106747901 T1 - Implementation of systems strategies for breast and cervical cancer screening services in health maintenance organizations. AU - Goins KV AU - Zapka JG AU - Geiger AM AU - Solberg LI AU - Taplin S AU - Yood MU AU - Gilbert J AU - Mouchawar J AU - Somkin CP AU - Weinmann S Y1 - 2003/11//2003 Nov N1 - Accession Number: 106747901. Language: English. Entry Date: 20040618. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Health Services Administration; Peer Reviewed; USA. Grant Information: Supported by grant U19 CA79689 from the National Institutes of Health, Bethesda, MD. NLM UID: 9613960. KW - Breast Neoplasms -- Diagnosis KW - Cancer Screening KW - Cervix Neoplasms -- Diagnosis KW - Health Maintenance Organizations KW - Adult KW - Case Studies KW - Decision Support Systems, Clinical KW - Female KW - Middle Age KW - Patient Education KW - Practice Guidelines -- Utilization KW - Quality Improvement KW - Reminder Systems KW - Survey Research KW - Funding Source KW - Human SP - 745 EP - 755 JO - American Journal of Managed Care JF - American Journal of Managed Care JA - AM J MANAGE CARE VL - 9 IS - 11 CY - Plainsboro, New Jersey PB - Intellisphere, LLC AB - Objective: To describe the systems strategies used to reduce failures in delivery of breast and cervical cancer screening services in HMOs with high performance rates for these services.Study Design: Multiple case study.Participants and Methods: Seven HMOs participated in an assessment of their breast and cervical cancer screening policies and procedures. Current clinical practice guidelines were analyzed, and key informants were interviewed about organizational policies and procedures that ensure initial screening and follow-up of abnormal results. Data were analyzed across plans for several theoretically relevant domains, including leadership and policies, clinical decision support, delivery system design, clinical information systems, and patient self-management support.Results: Practice guidelines were fundamentally similar across plans for both cancer screenings, although operationalization of risk and formatting of the written documents differed. These plans adopted a wide array of strategies, particularly in the clinical decision support, clinical information systems, and patient self-management support domains, but there is room for improvement. Differences among plans and between strategies for breast and cervical cancer screening provide new understanding of how to approach this problem.Conclusions: Organizations seeking to improve performance of breast and cervical cancer screening should consider multiple strategies aimed at multiple targets and should ensure that strategies used for one type of cancer are considered for others. SN - 1088-0224 AD - Division of Preventive and Behavioral Medicine, Meyers Primary Care Institute/University of Massachusetts Medical School, 55 Lake Ave N, Worcester, MA 01655; karin.goins@umassmed.edu U2 - PMID: 14626472. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106747901&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106769196 T1 - [Commentary on] Radiation therapy plus tamoxifen versus tamoxifen alone after breast-conserving surgery in postmenopausal women with stage I breast cancer: a decision analysis. AU - Wallace HJ Y1 - 2003/09//2003 Sep N1 - Accession Number: 106769196. Language: English. Entry Date: 20040820. Revision Date: 20150711. Publication Type: Journal Article; abstract; commentary. Original Study: Punglia RS, Kuntz KM, Lee JH, Recht A. Radiation therapy plus tamoxifen versus tamoxifen alone after breast-conserving surgery in postmenopausal women with stage I breast cancer: a decision analysis. (J CLIN ONCOL) 6/15/2003; 21 (12): 2260-2267. Journal Subset: Biomedical; Editorial Board Reviewed; Europe; Peer Reviewed; UK & Ireland. NLM UID: 101128014. KW - Breast Neoplasms -- Drug Therapy KW - Breast Neoplasms -- Radiotherapy KW - Combined Modality Therapy KW - Lumpectomy KW - Postmenopause -- Physiology KW - Aged KW - Aged, 80 and Over KW - Comparative Studies KW - Decision Support Systems, Clinical KW - Disease Progression KW - Female KW - Middle Age KW - Recurrence SP - 245 EP - 246 JO - Women's Oncology Review JF - Women's Oncology Review JA - WOMENS ONCOL REV VL - 3 IS - 3 CY - Philadelphia, Pennsylvania PB - Taylor & Francis Ltd SN - 1473-3404 AD - University of Vermont Medical College, Burlington, VT UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106769196&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106751708 T1 - Radiation therapy plus tamoxifen versus tamoxifen alone after breast-conserving surgery in postmenopausal women with stage I breast cancer: a decision analysis. AU - Punglia RS AU - Kuntz KM AU - Lee JH AU - Recht A Y1 - 2003/06/15/ N1 - Accession Number: 106751708. Language: English. Entry Date: 20040702. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Commentary: Wallace HJ. [Commentary on] Radiation therapy plus tamoxifen versus tamoxifen alone after breast-conserving surgery in postmenopausal women with stage I breast cancer: a decision analysis. (WOMENS ONCOL REV) 2003 Sep; 3 (3): 245-246. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Grant Information: Supported in part by a fellowship from the Agency for Healthcare Research and Quality, Rockville, MD (32 HS00020-16). NLM UID: 8309333. KW - Breast Neoplasms -- Therapy KW - Tamoxifen -- Therapeutic Use KW - Antineoplastic Agents, Hormonal -- Therapeutic Use KW - Chemotherapy, Adjuvant KW - Receptors, Cell Surface KW - Breast Neoplasms -- Radiotherapy KW - Combined Modality Therapy KW - Decision Making, Clinical KW - Postmenopause KW - Middle Age KW - Aged KW - Aged, 80 and Over KW - Female KW - Funding Source KW - Human SP - 2260 EP - 2267 JO - Journal of Clinical Oncology JF - Journal of Clinical Oncology JA - J CLIN ONCOL VL - 21 IS - 12 CY - Alexandria, Virginia PB - American Society of Clinical Oncology AB - PURPOSE: To compare outcomes for hypothetical cohorts of postmenopausal patients with estrogen receptor-positive tumors that are < or = 2 cm in size, with pathologically uninvolved axillary nodes, treated with radiation therapy plus tamoxifen versus tamoxifen alone after breast-conserving surgery. METHODS: A Markov model was used to simulate patients' clinical course and estimate overall survival, recurrence-free survival, time with an intact breast, and death from breast cancer. Probabilities were derived from randomized trials and retrospective studies. Analyses were performed separately by age of diagnosis in 5-year increments from 50 to 80 years. Sensitivity analyses tested the stability of radiation benefit. RESULTS: The modeled recurrence-free survival benefit of giving radiation therapy was 3.35 years for women who were 50 years of age at diagnosis, versus 0.61 years for women who were 80 years of age. In the 50-year-old cohort, radiation therapy resulted in additional 0.60 years survival, compared with 0.04 years among 80-year-olds. A 50-year-old woman who received radiation therapy plus tamoxifen was less likely to die from breast cancer than if she received tamoxifen alone (2.43% v 5.29%; relative-risk reduction, 54%). An 80-year-old woman had a 1.17% chance of dying from breast cancer if she received radiation therapy plus tamoxifen, versus 2.02% with tamoxifen alone (relative-risk reduction, 42%). Sensitivity analyses showed that the magnitude of benefit was strongly influenced by including unequal rates of developing distant disease after breast recurrence between the treatment arms and varying rates of local recurrence. CONCLUSION: The absolute and relative benefits of radiation therapy and individual patient preferences for different health states should be considered when selecting treatment. Copyright © 2003 by American Society of Clinical Oncology SN - 0732-183X AD - Brigham and Women's Hospital, Dept of Radiation Oncology, 75 Francis St, L2, Boston, MA 02115; rpunglia@lroc.harvard.edu U2 - PMID: 12805324. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106751708&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106885651 T1 - Australian women's prediagnostic decision-making styles, relating to treatment choices for early breast cancer treatment. AU - Budden LM AU - Pierce PF AU - Hayes BA AU - Buettner PG Y1 - 2003///2003 Summer N1 - Accession Number: 106885651. Language: English. Entry Date: 20031121. Revision Date: 20150820. Publication Type: Journal Article; research; tables/charts. Journal Subset: Core Nursing; Nursing; Peer Reviewed; USA. Instrumentation: Michigan Assessment of Decision Style (MADS) (Pierce); Pre-Decision Portfolio Questionnaire. Grant Information: Merit Research Grant from James Cook University, Australia. NLM UID: 101146940. KW - Breast Neoplasms -- Therapy KW - Decision Making, Patient -- Evaluation -- Queensland KW - Adult KW - Age Factors KW - Aged KW - Analysis of Variance KW - Chi Square Test KW - Confidence Intervals KW - Data Analysis Software KW - Demography KW - Descriptive Research KW - Descriptive Statistics KW - Educational Status KW - Employment KW - Female KW - Fisher's Exact Test KW - Funding Source KW - Mammography KW - Middle Age KW - Multiple Linear Regression KW - Nonparametric Statistics KW - Nonprobability Sample KW - Occupations and Professions KW - Outpatients KW - Physician-Patient Relations KW - Queensland KW - Questionnaires KW - Summated Rating Scaling KW - Survey Research KW - T-Tests KW - Human SP - 117 EP - 136 JO - Research & Theory for Nursing Practice JF - Research & Theory for Nursing Practice JA - RES THEORY NURS PRACT VL - 17 IS - 2 CY - New York, New York PB - Springer Publishing Company, Inc. AB - Women diagnosed with early breast cancer are now asked by their doctors to choose from a range of options for their preferred medical treatment plan. Little information is known about women's treatment decision-making and therefore nurses do not have evidence to guide this decision support. The aim of this descriptive survey was to investigate the prediagnostic decision-making behavior of a sample (N = 377) of Australian women, regarding their treatment choices for early breast cancer. The data were collected using the Pre-Decision Portfolio Questionnaire (PDPQ) by Pierce (1996), which includes the Michigan Assessment of Decision Styles (MADS). Of 366 participating women, 19.9% strongly agreed to all three items of the MADS factor Deferring Responsibility; 0.3% strongly agreed to all four factors of Avoidance; 32.7% strongly agreed on all four items of Information Seeking; and 63.4% strongly agreed to all five items of Deliberation. Women showed a variety of preferred decision styles, depending on age, education, occupation and employment status. Only 36% of women indicated it was critically important to 'get the treatment over as soon as possible;' 55% to 'participate in selecting treatment;' and 53% to 'read a lot of information:' The understanding of factors that are important to women when they are making decisions for medical treatment is a mandatory step in designing customized evidence-based decision support, which can be delivered by nurses to help women during this distressing experience. SN - 1541-6577 AD - Senior Lecturer, School of Nursing Sciences, James Cook University, Townsville, 4811 Queensland, Australia; Lea.Budden@jcu.edu.au U2 - PMID: 12880217. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106885651&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106694970 T1 - Helping patients make informed choices: a randomized trial of a decision aid for adjuvant chemotherapy in lymph node-negative breast cancer. AU - Whelan T AU - Sawka C AU - Levine M AU - Gafni A AU - Reyno L AU - Willan A AU - Julian J AU - Dent S AU - Abu-Zahra H AU - Chouinard E AU - Tozer R AU - Pritchard K AU - Bodendorfer I Y1 - 2003/04/16/ N1 - Accession Number: 106694970. Language: English. Entry Date: 20040123. Revision Date: 20150711. Publication Type: Journal Article; clinical trial; research; tables/charts. Commentary: O'Connor AM, Mulley AG Jr., Wennberg JE. Standard consultations are not enough to ensure decision quality regarding preference-sensitive options. (J NATL CANCER INST) 4/16/2003; 95 (8): 570-571. Journal Subset: Biomedical; Peer Reviewed; USA. Instrumentation: Decisional Conflict Instrument; State-Trait Anxiety Inventory (STAI) (Spielberger). Grant Information: Canadian Breast Cancer Research Initiative. NLM UID: 7503089. KW - Decision Making, Patient KW - Breast Neoplasms -- Therapy KW - Chemotherapy, Adjuvant KW - Consumer Participation KW - State-Trait Anxiety Inventory KW - Health Knowledge KW - Anxiety KW - Audiovisuals KW - Research Instruments KW - Psychological Tests KW - Patient Satisfaction KW - Clinical Trials KW - T-Tests KW - Repeated Measures KW - Analysis of Variance KW - Confidence Intervals KW - Female KW - Funding Source KW - Human SP - 581 EP - 587 JO - JNCI: Journal of the National Cancer Institute JF - JNCI: Journal of the National Cancer Institute JA - J NATL CANCER INST VL - 95 IS - 8 PB - Oxford University Press / USA SN - 0027-8874 AD - Supportive Cancer Care Research Unit, Hamilton Regional Cancer Center, 699 Concession St, Rm 3-62, Hamilton, ON L8V 5C2 Canada; tim.whelan@hrcc.on.ca U2 - PMID: 12697850. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106694970&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106711408 T1 - Development of an interactive decision aid for female BRCA1/BRCA2 carriers. AU - Kaufman EM AU - Peshkin BN AU - Lawrence WF AU - Shelby R AU - Isaacs C AU - Brown K AU - Rispoli J AU - O'Neill S AU - Hurley K AU - DeMarco T AU - Brogan B AU - Grumet S AU - Jandorf L AU - McKenna K AU - Valdimarsdottir H AU - Schwartz MD Y1 - 2003/04// N1 - Accession Number: 106711408. Language: English. Entry Date: 20040312. Revision Date: 20150711. Publication Type: Journal Article; pictorial. Journal Subset: Biomedical; Continental Europe; Europe; Peer Reviewed. NLM UID: 9206865. KW - Breast Neoplasms -- Familial and Genetic KW - CD ROM KW - Decision Making, Patient KW - Genetic Counseling KW - Female KW - Risk Management SP - 109 EP - 129 JO - Journal of Genetic Counseling JF - Journal of Genetic Counseling JA - J GENETIC COUNS VL - 12 IS - 2 CY - , PB - Springer Science & Business Media B.V. AB - Shared decision making between patients and providers is becoming increasingly common, particularly when there is no clear preferred course of action. As a result, decision aids are being adopted with growing frequency and have been applied to many medical decision-making issues. One such issue where there is uncertainty is breast cancer risk management among BRCA1/BRCA2 carriers. We present the development of a CD-ROM decision aid to facilitate risk management decision making in this population. Our decision aid was developed with the intention of providing it through a randomized clinical trial. The CD-ROM is a multimedia, interactive intervention which provides information about breast cancer, risks associated with BRCA1 and BRCA2 mutations, risk management options for hereditary breast cancer, and a breast cancer risk management decision aid. The goal of this CD-ROM, offered as an adjunctive intervention, is to reduce decisional conflict and psychological distress and improve comprehension of risk information, decisional satisfaction, medical adherence, and quality of life for this population of women at increased risk for breast cancer. SN - 1059-7700 AD - Division of Cancer Control, Dept of Oncology, Georgetown University -- Lombardi Cancer Center, 2233 Wisconsin Ave, NW Suite 317, Washington DC 20007; emk6@georgetown.edu UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106711408&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106683035 T1 - Decision-making for patients with resectable breast cancer: individualized decisions for and by patients and their physicians. AU - Loprinzi CL AU - Ravdin PM Y1 - 2003/04//2003 Apr N1 - Accession Number: 106683035. Language: English. Entry Date: 20040924. Revision Date: 20150711. Publication Type: Journal Article; tables/charts. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 101162515. KW - Breast Neoplasms -- Surgery KW - Chemotherapy, Adjuvant KW - Decision Making, Clinical KW - Physician-Patient Relations KW - Breast Neoplasms -- Prognosis KW - Female SP - 189 EP - 196 JO - Journal of the National Comprehensive Cancer Network JF - Journal of the National Comprehensive Cancer Network JA - J NATL COMPR CANCER NETW JNCCN VL - 1 IS - 2 CY - Cold Spring Harbor, New York PB - Harborside Press AB - Decisions regarding the use of adjuvant cytotoxic and hormonal therapies for women with breast cancer ideally should be made jointly by the patient and oncologist. For patients to be adequately involved in this decision-making process, they must be provided with appropriate education regarding the potential benefits and risks of adjuvant therapies. The recommended steps for doing this are: 1) understand baseline prognosis with locoregional therapy (surgery, radiation, or both) alone for the individual patient at hand; 2) determine the estimated benefit afforded by adjuvant therapy options for the individual patient; 3) estimate the risk of side effects of adjuvant therapy options; 4) convey the above information to the individual patient; 5) facilitate the individual patient's decision regarding adjuvant systemic therapy; and 6) support the patient's decision. Two computer-based tools (Numeracy and Adjuvant!) are available to facilitate this process. SN - 1540-1405 AD - Mayo Clinic, Rochester, MN U2 - PMID: 19768877. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106683035&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106713962 T1 - Development and evaluation of a breast cancer prevention decision aid for higher-risk women. AU - Stacey D AU - O'Connor AM AU - DeGrasse C AU - Verma S Y1 - 2003/03// N1 - Accession Number: 106713962. Language: English. Entry Date: 20070101. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Europe; Health Services Administration; Peer Reviewed; UK & Ireland. Instrumentation: Impact of Events Scale (IES); Decisional Conflict Scale. NLM UID: 9815926. KW - Breast Neoplasms -- Prevention and Control KW - Counseling KW - Decision Making, Patient KW - Risk Assessment KW - Aged KW - Audiorecording KW - Convenience Sample KW - Data Analysis Software KW - Data Analysis, Statistical KW - Descriptive Statistics KW - Female KW - Impact of Events Scale KW - McNemar's Test KW - Middle Age KW - P-Value KW - Paired T-Tests KW - Pamphlets KW - Pretest-Posttest Design KW - Questionnaires KW - Research Instruments KW - Scales KW - Self Report KW - Wilcoxon Signed Rank Test KW - Human SP - 3 EP - 18 JO - Health Expectations JF - Health Expectations JA - HEALTH EXPECTATIONS VL - 6 IS - 1 CY - Malden, Massachusetts PB - Wiley-Blackwell AB - OBJECTIVE: To develop and evaluate the effectiveness of a breast cancer prevention decision aid for women aged 50 and older at higher risk of breast cancer. DESIGN: Pre-test-post-test study using decision aid alone and in combination with counselling. SETTING: Breast Cancer Risk Assessment Clinic. PARTICIPANTS: Twenty-seven women aged 50-69 with 1.66% or higher 5-year risk of breast cancer. INTERVENTION: Self-administered breast cancer prevention decision aid. MAIN OUTCOME MEASURES: Acceptability; decisional conflict; knowledge; realistic expectations; choice predisposition; intention to improve life-style practices; psychological distress; and satisfaction with preparation for consultation. RESULTS: The decision aid alone, or in combination with counselling, decreased some dimensions of decisional conflict, increased knowledge (P < 0.01), and created more realistic expectations (P < 0.01). The aid in combination with counselling, significantly reduced decisional conflict (P < 0.01) and psychological distress (P < 0.02), helped the uncertain become certain (P < 0.02), and increased intentions to adopt healthier life-style practices (P < 0.03). Women rated the aid as acceptable, and both women and practitioners were satisfied with the effect it had on the counselling session. CONCLUSION: The decision aid shows promise as a useful decision support tool. Further research should compare the effect of the decision aid in combination with counselling to counselling alone. SN - 1369-6513 U2 - PMID: 12603624. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106713962&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106786016 T1 - Informed consent for breast screening: what should we tell women? AU - Marshall T AU - Adab P Y1 - 2003/03// N1 - Accession Number: 106786016. Language: English. Entry Date: 20031205. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Editorial Board Reviewed; Europe; Peer Reviewed; UK & Ireland. NLM UID: 9433359. KW - Consent KW - Cancer Screening KW - Breast Neoplasms -- Mortality KW - Risk Assessment KW - Referral and Consultation KW - Knowledge KW - Middle Age KW - Aged KW - Female KW - Human SP - 22 EP - 26 JO - Journal of Medical Screening JF - Journal of Medical Screening JA - J MED SCREEN VL - 10 IS - 1 PB - Sage Publications, Ltd. AB - OBJECTIVE: To illustrate visually the lifetime probabilities of the principal outcomes of the UK breast screening programme in a readily understandable format. METHODS: We derived prognostic data from a modelling exercise using published effectiveness data and routine data sources. We calculated the probability that a woman will survive to the age of 75 if she chooses to participate fully in breast screening from age 50 to 64 and if she chooses not to participate. We also calculated her probability of being referred for assessment, undergoing fine-needle biopsy and undergoing open biopsy. We present these data in two alternative decision aid formats. These alternative formats illustrate visually the outcomes for 1000 women and 100 women choosing each alternative: breast screening or no breast screening. RESULTS: A woman participating in breast screening from age 50 to 64 increases her chances of surviving to age 75 by 0.6%. She has a 21.8% probability of surviving to age 75 and being referred for assessment but no further investigation. She has a 5.7% probability of undergoing core biopsy and a 0.9% probability of undergoing open biopsy. This information can easily be presented visually. CONCLUSIONS: We can provide realistic estimates of the effects of the breast screening programme on mortality in a readily understandable format. If we wish women to make an informed choice about breast screening they must be given this information. SN - 0969-1413 AD - Department of Public Health and Epidemiology, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; T.P.Marshall@bham.ac.uk U2 - PMID: 12790312. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106786016&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106714645 T1 - The benefits and costs of tamoxifen for breast cancer prevention. AU - Eckerman SD AU - Martin AJ AU - Stockler MR AU - Simes RJ Y1 - 2003/02// N1 - Accession Number: 106714645. Language: English. Entry Date: 20040319. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Australia & New Zealand; Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; Public Health. NLM UID: 9611095. KW - Breast Neoplasms -- Prevention and Control KW - Tamoxifen -- Economics KW - Tamoxifen -- Therapeutic Use KW - Breast Neoplasms -- Epidemiology KW - Breast Neoplasms -- Mortality KW - Confidence Intervals KW - Descriptive Statistics KW - Female KW - Prospective Studies KW - Relative Risk KW - Sensitivity and Specificity KW - Tamoxifen -- Adverse Effects KW - Human SP - 34 EP - 40 JO - Australian & New Zealand Journal of Public Health JF - Australian & New Zealand Journal of Public Health JA - AUST NZ J PUBLIC HEALTH VL - 27 IS - 1 CY - Malden, Massachusetts PB - Wiley-Blackwell AB - OBJECTIVE: To estimate the effects of key uncertainties on the effectiveness and cost-effectiveness of breast cancer prevention with tamoxifen. METHODS: The incremental cost-effectiveness ratio of tamoxifen therapy relative to placebo was estimated using decision analysis with Markov modelling of health states, outcomes and costs for a simulated cohort of women at high risk for breast cancer. Relative effects of tamoxifen's benefits and harms were estimated from meta-analyses of randomised controlled trials. Cost estimates were based on Australian treatment patterns and costs. The main outcome measure was cost per quality-adjusted life year (QALY) gained with costs and effects discounted at a 5% annual rate. RESULTS: Tamoxifen therapy over five years reduces the incidence of breast cancer by approximately 1.4%, which is offset by an increase in endometrial cancer of 0.7% and pulmonary embolism of 0.2%. If the reduction is permanent (preventing new breast cancers emerging over five years and no further treatment effect thereafter), the model estimates an increase in life expectancy of 0.057 QALYs and an extra cost of $2,193; or $38,271/QALY gained. A model assuming further treatment effects of tamoxifen preventing new breast cancers emerging for up to 10 years results in an incremental cost of $19,354/QALY. However, if five years of tamoxifen therapy merely delays when these breast cancers appear (such that by 10 years there is no longer a reduced incidence), the incremental cost per QALY saved is estimated to be $199,149. CONCLUSIONS: Tamoxifen is potentially cost-effective in preventing breast cancer in women at high risk. However, its cost-effectiveness as a preventive therapy is highly sensitive to whether these cancers are permanently prevented or their clinical presentation is only delayed. Long-term follow-up in randomised controlled trials is therefore crucial in forming health policy. SN - 1326-0200 AD - National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Locked Bag 77, Camperdown NSW 1450; simon@ctc.usyd.edu.au U2 - PMID: 14705265. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106714645&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106821537 T1 - Feasibility of using computer-assisted intervention to enhance the way women with breast cancer communicate with their physicians. AU - Davison BJ AU - Degner LF Y1 - 2002/12// N1 - Accession Number: 106821537. Language: English. Entry Date: 20030411. Revision Date: 20150820. Publication Type: Journal Article; clinical trial; questionnaire/scale; research; tables/charts. Journal Subset: Core Nursing; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Nursing; Peer Reviewed; USA. Instrumentation: Control Preferences Scale (Degner); Patient Satisfaction Questionnaire (PSQ). Grant Information: Canadian Breast Cancer Research Initiative, National Cancer Institute of Canada. NLM UID: 7805358. KW - Cancer Patients KW - Breast Neoplasms KW - Physician-Patient Relations KW - Decision Making, Patient KW - Computers and Computerization KW - Communication KW - Funding Source KW - Urban Areas KW - Clinical Trials KW - Convenience Sample KW - Patient Satisfaction -- Evaluation KW - Men KW - Attitude Measures KW - Software KW - Information Needs KW - Descriptive Statistics KW - T-Tests KW - Content Analysis KW - Chi Square Test KW - Summated Rating Scaling KW - Coefficient Alpha KW - Middle Age KW - Female KW - Human SP - 417 EP - 424 JO - Cancer Nursing JF - Cancer Nursing JA - CANCER NURS VL - 25 IS - 6 CY - Baltimore, Maryland PB - Lippincott Williams & Wilkins AB - This study was conducted to evaluate the feasibility of using a computer intervention to enhance communication between healthcare professionals and women with breast cancer. Additional aims were to measure the extent to which women achieved their preferred decisional roles and satisfaction with the clinical medical appointment. This two-arm randomized clinical trial design included a convenience sample of 749 women with breast cancer attending 3 urban Canadian outpatient oncology clinics. Most women were older than 50 years and had a high school diploma or greater (57%). Women in the control group completed measures of decision preference before their clinic appointments. Women in the intervention group were encouraged to use the information and decision preference profiles generated by the computer program at their clinic appointments. Levels of involvement in decision making and satisfaction were measured after the clinic appointments. Results showed that although the majority of women in both groups did assume their preferred roles in decision making, a significantly higher proportion of women in the intervention group reported playing a more passive role than originally planned. Both groups reported high satisfaction levels. Future research is required to study how this computer intervention could be used by clinicians to provide information and decision support to these women. SN - 0162-220X AD - The Prostate Centre, Room C328-2733 Heather St, Vancouver General Hospital, Vancouver, British Columbia V5 3J5, Canada; jdavison@vanhosp.bc.ca U2 - PMID: 12464832. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106821537&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106983742 T1 - The experience of using decisional support aids by patients with breast cancer. AU - Lacey MD Y1 - 2002/11// N1 - Accession Number: 106983742. Language: English. Entry Date: 20050817. Revision Date: 20150819. Publication Type: Journal Article; research; tables/charts. Journal Subset: Core Nursing; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Nursing; Peer Reviewed; USA. Grant Information: Funded by an ONS Foundation Research grant, supported by Chiron Therapeutics. NLM UID: 7809033. KW - Cancer Patients KW - Breast Neoplasms KW - Decision Making, Patient KW - Questionnaires KW - Funding Source KW - World Wide Web KW - Information Resources KW - Life Experiences KW - Descriptive Research KW - Phenomenological Research KW - Audiorecording KW - Interviews KW - Thematic Analysis KW - Purposive Sample KW - Oncologic Nursing KW - Nurse-Patient Relations KW - Breast Neoplasms -- Psychosocial Factors KW - Multidisciplinary Care Team KW - Qualitative Studies KW - United States KW - Suburban Areas KW - Interview Guides KW - Adult KW - Middle Age KW - Aged KW - Female KW - Human SP - 1491 EP - 1497 JO - Oncology Nursing Forum JF - Oncology Nursing Forum JA - ONCOL NURS FORUM VL - 29 IS - 10 CY - Pittsburgh, Pennsylvania PB - Oncology Nursing Society AB - PURPOSE/OBJECTIVES: To explore the lived experience of patients with breast cancer using decisional support aids during the prediagnosis, diagnosis, and treatment phases of their disease. RESEARCH APPROACH: Descriptive, phenomenologic. SETTING: Community-based. PARTICIPANTS: 12 women, ages 38-68, diagnosed with and treated for breast cancer. METHODOLOGIC APPROACH: Audiotaped interviews were transcribed and analyzed according to Colaizzi's method. MAIN RESEARCH VARIABLES: Use of decisional support aids. FINDINGS: Six major themes were identified: being too stressed and overwhelmed to make a decision, feeling an internal sense of urgency to have the breast cancer managed quickly, trusting the opinion and advice of physicians about treatment decisions, appreciating the importance of support from family and friends in decision making, finding nurses were unavailable or uninvolved in decision making initially, and missing out on the benefits of a multidisciplinary approach. CONCLUSIONS: Being presented with the diagnosis of breast cancer evokes a range of feelings and emotions. By identifying, explaining, and expressing their accounts, participants revealed their lived experience and its meaning. The description of this phenomena may assist other women diagnosed with breast cancer in the decision-making process. INTERPRETATION: Oncology nurses need to be aware of and understand the issues surrounding the decision-making process of patients with breast cancer. Gaps clearly exist in the information and support provided to these participants. Nurses must target areas that are insufficient in providing decisional support aids and plan for partnerships to ensure a multidisciplinary approach in this process. SN - 0190-535X AD - Chair and an Associate Professor, Department of Nursing, Eastern University, St. David's, PA; mlacey@eastern.edu U2 - PMID: 12432419. DO - 10.1188/02.ONF.1491-1497 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106983742&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 89291465 T1 - Recursive partitioning identifies patients at high and low risk for ipsilateral tumor recurrence after breast-conserving surgery and radiation. AU - Freedman, G. M. AU - Hanlon, A. L. AU - Fowble, B. L. AU - Anderson, P. R. AU - Nicoloau, N. AU - Nicolaou, N Y1 - 2002/10//10/1/2002 N1 - Accession Number: 89291465. Language: English. Entry Date: 20030221. Revision Date: 20161120. Publication Type: journal article. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 8309333. KW - Breast Neoplasms -- Therapy KW - Breast Neoplasms -- Pathology KW - Neoplasm Recurrence, Local -- Diagnosis KW - Female KW - Age Factors KW - Risk Assessment KW - Adult KW - Antineoplastic Agents, Combined -- Therapeutic Use KW - Breast Neoplasms -- Drug Therapy KW - Prognosis KW - Axilla -- Surgery KW - Breast Neoplasms -- Surgery KW - Chemotherapy, Adjuvant KW - Combined Modality Therapy KW - Decision Trees KW - Aged KW - Survival Analysis KW - Breast Neoplasms -- Radiotherapy KW - Lymph Node Excision KW - Middle Age KW - Tamoxifen -- Administration and Dosage KW - Aged, 80 and Over KW - Lumpectomy KW - Prospective Studies SP - 4015 EP - 4021 JO - Journal of Clinical Oncology JF - Journal of Clinical Oncology JA - J CLIN ONCOL VL - 20 IS - 19 CY - Alexandria, Virginia PB - American Society of Clinical Oncology AB - Purpose: Recursive partitioning analysis (RPA), a method of building decision trees of significant prognostic factors for outcome, was used to determine subgroups at significantly different risk for ipsilateral breast tumor recurrence (IBTR) in early-stage breast cancer.Patients and Methods: Nine hundred twelve women underwent breast-conserving surgery, axillary dissection, and radiation. Systemic therapy was chemotherapy with or without tamoxifen in 32%, tamoxifen in 27%, or none in 41%. RPA was used to create a decision tree according to predictive variables that classify patients by IBTR risk, and the Kaplan-Meier method was used to calculate 10-year risks. Median follow-up was 5.9 years.Results: Age was the first split in the partition tree. Patients more than 55 years old had a 4% 10-year IBTR, the only further division being use of tamoxifen or not (2% v 5%, P =.03). For patients /= 1 child living at home were identified through purposive sampling.MethodsMen participated in individual, semi-structured interviews of 1-2 hours, which were conducted by male nurses. Interviews focused on men's perceptions of their experience and their family's experience of coping with breast cancer. Interviews were audiotaped and transcribed, and analysed using the constant comparative method.Main findingsMen's coping was characterised by 2 major themes: focusing on their wives' illness and care and focusing on the family to keep life going. 9 subthemes were identified, each of which predominantly reflected one of the 2 major themes, although most reflected both themes to some extent. Focusing on a wife's illness and care was reflected in men's efforts to understand, assist with decision making, get through treatment, and deal with the healthcare system. 3 subthemes were associated with this major theme. Being there meant that men wanted to be physically present and emotionally supportive. They wanted to accompany their wives to appointments, access information and services, and provide care. Most felt unprepared and did not know what to do or how to behave. Men relied on healthcare professionals to give competent care, and to provide support and assistance. They wanted to be treated with respect and compassion and to have their views considered and respected. Being informed and contributing to decision making involved learning about cancer, assisting with and supporting their wives' decisions, and informing children, family, and friends.The second major theme was focusing on family to keep life going amid the stress and disruption from the illness. 6 subthemes related to this theme. Most men were challenged by trying to keep patterns normal, as they struggled to keep family routines and activities intact, especially for the children. For family life to continue, men had to help out and rely on others to undertake household and child care activities. Men felt stretched and overwhelmed, particularly when helping at home was unfamiliar. Men spoke about trying to be positive and to have positive people around them. They were strengthened by their wives' positive attitudes, although spouses often protected each other by not sharing fears and emotions. Most men helped by putting [their] self on hold. Initially, they were totally consumed by the cancer, its treatment, and keeping family life going; many automatically put their own needs as secondary to their wives' needs. Men talked about adapting work life to balance work and home demands. Some adapted work patterns and wished they had taken more time off, whereas others saw work as an escape. Managing finances was an added stress as men tried to deal with unexpected reduced incomes and increased expenses.ConclusionMen's experiences of coping with their partners' breast cancer and treatment were reflected in the 2 major themes of focusing on their wives' illness and care and focusing on family to keep life going. [Original article accession number: 2000052916 (research)] SN - 1367-6539 AD - Clinical Nurse Specialist, Practice Development and Research, Cancer Care, UCL Hospitals NHS Trust, London, UK UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107023974&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - THES ID - 109877289 T1 - The impact of breast cancer on the family: a phenomenological study of families with adolescents. AU - Rea GB Y1 - 2001/01// N1 - Accession Number: 109877289. Language: English. Entry Date: 20040611. Revision Date: 20150923. Publication Type: Doctoral Dissertation; research. KW - Breast Neoplasms -- Psychosocial Factors KW - Family -- Psychosocial Factors KW - Life Experiences KW - Adolescence KW - Conceptual Framework KW - Convenience Sample KW - Family Attitudes KW - Family Systems Theory KW - Female KW - Interviews KW - Midwestern United States KW - Models, Theoretical KW - Physical Therapist Attitudes KW - Qualitative Studies KW - Human SP - 183 p EP - 183 p JO - Impact of Breast Cancer on the Family: A Phenomenological Study of Families With Adolescents JF - Impact of Breast Cancer on the Family: A Phenomenological Study of Families With Adolescents PB - Saint Louis University AB - The purpose of the study was to investigate the impact of breast cancer on the lived experience of families with adolescents, as perceived by the patient, spouse, and adolescent, and the family unit. Family systems, family development, and Combrinck-Graham's family spiral model were the guiding theories for this qualitative study. The convenience sample of families included in this study came from cancer support programs within a midwestern metropolitan region.Five families were interviewed. The women had been diagnosed with Stage I or II non-metastatic breast cancer and had completed their adjunctive therapy. The diagnosis of breast cancer had been made within the fourteen months prior to the interviews. Interviews with the patients, spouses, and adolescents and the family unit explored the research questions: What is the impact of breast cancer on the individual lived experience of the patient, spouse, and adolescent? What is the impact of breast cancer on the lived experience of the families with adolescents?The themes identified from the patient interviews included gathering support, becoming self-focused, decision making, and expanding focus to family. The interviews with the spouses revealed the themes of becoming focused on their wives and breast cancer, taking action/coping, fear of not being able to meet their spouses' or children's needs, feeling responsible for the family's well-being, being protective of their spouse's needs, returning to normal, and sharing with others. Themes identified from the adolescent interviews included: not knowing, changes of family roles and awareness of behavior, and altering plans. Themes unique to the family interviews included: anxious beginnings, spiritual experience, role of humor, positive reform, increasing appreciation of each other, and honor and celebration.Implications for nursing and psychotherapy research, theory, and practice were identified. This knowledge will prove useful in developing strategies for caring for these individuals. SN - 9780493668017 AV - UMI Order AAI3051830 M1 - Ph.D. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109877289&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 106783469 T1 - Decision analysis of tamoxifen for the prevention of invasive breast cancer. AU - Grann VR AU - Sundararajan V AU - Jacobson JS AU - Whang W AU - Heitjan DF AU - Antman KH AU - Neugut AI Y1 - 2000/05//May/Jun2000 N1 - Accession Number: 106783469. Language: English. Entry Date: 20060901. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. Grant Information: Supported in part by grant no CRTG-98-260-01 from the American Cancer Society, Atlanta, GA, grant no P30 CA13696-26 Cancer Center Support Grant from the National Cancer Institute (NCI), and an NCI-funded postdoctoral fellowship (T32-CA09529). NLM UID: 100931981. KW - Breast Neoplasms -- Prevention and Control KW - Survival KW - Tamoxifen -- Therapeutic Use KW - Adult KW - Age Factors KW - Breast Neoplasms -- Economics KW - Cost Benefit Analysis KW - Data Analysis Software KW - Data Analysis, Statistical KW - Descriptive Statistics KW - Female KW - Middle Age KW - Quality of Life KW - Funding Source KW - Survival Analysis KW - Tamoxifen -- Economics KW - Human SP - 169 EP - 178 JO - Cancer Journal JF - Cancer Journal JA - CANCER J VL - 6 IS - 3 CY - Baltimore, Maryland PB - Lippincott Williams & Wilkins AB - PURPOSE: The recent Breast Cancer Prevention Trial has shown that tamoxifen may prevent invasive breast cancer. We used a Markov model to estimate the long-term effects of chemoprevention with tamoxifen on survival, quality-adjusted survival, and health care costs. METHODS: We used a hypothetical cohort of women with breast-cancer risk similar to that of participants in the Breast Cancer Prevention Trial, and a computer-based decision analysis (Markov model and 500 Monte Carlo simulations) to model the outcomes of interest. Survival calculations were from Surveillance, Epidemiology, and End-Results (SEER) data; preference ratings from a time trade-off questionnaire administered to a group of average-risk women; and cost estimates from the Group Health Cooperative of Puget Sound and the Health Care Financing Administration. We obtained utility measures for quality-adjustment by administering a time trade-off questionnaire to a group of community-based women. RESULTS: Use of tamoxifen prolonged the average survival of cohort members by 69 days (95% probability interval [PI] 27 to 117) for those who started use at age 35 years; 40 days (95% PI 16 to 67) for those who started use at age 50 years; and 27 days (95% PI 14 to 40) for those who started use at age 60 years. Tamoxifen extended quality-adjusted survival by 38 days (95% PI 0.1 to 82) at age 35, 25 days (95% PI 0 to 50) at age 50, and 22 days (95% PI 5 to 39) days at age 60. Chemoprevention with tamoxifen cost $46,619 (95% PI $27,928 to $98,796) per life year life saved for women who started at age 35; for women over age 50, it cost more than $50,000 per life year saved. DISCUSSION: Tamoxifen use may improve long-term survival and quality-adjusted survival among women who are at increased risk of breast cancer, but this benefit diminishes with age. Tamoxifen is cost-effective in comparison with other cancer treatment strategies for younger women only. SN - 1528-9117 AD - Director of Health Outcomes Research, Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, PH18-201A, 630 West 168th J Street, New York, NY 10032 U2 - PMID: 10882333. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106783469&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107110839 T1 - A cross-cultural consumer-based decision aid for screening mammography. AU - Lawrence VA AU - Streiner D AU - Hazuda HP AU - Naylor R AU - Levine M AU - Gafni A Y1 - 2000/03//2000 Mar N1 - Accession Number: 107110839. Language: English. Entry Date: 20000501. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. Grant Information: San Antonio Cancer Institute, National Cancer Institute P30CA54174; Developmental Research Funds of the San Antonio Breast Cancer SPORE, National Cancer Institute P50CA58183; Mexican American Medical Treatment Effectiveness Research Center at the University of Texas Health Science Center at San Antonio, Agency for Health Care Policy and Research 1-UO1-HS07397; and Hispanic Healthy Aging Center, National Institute on Aging 1-P20-AG12044. NLM UID: 0322116. KW - Mammography -- Education KW - Decision Making, Patient KW - Breast Neoplasms -- Education KW - Validation Studies KW - Hispanics KW - Whites KW - Reliability and Validity KW - Risk Assessment KW - P-Value KW - Sensitivity and Specificity KW - Middle Age KW - Aged KW - Female KW - Funding Source KW - Human SP - 200 EP - 208 JO - Preventive Medicine JF - Preventive Medicine JA - PREV MED VL - 30 IS - 3 CY - Burlington, Massachusetts PB - Academic Press Inc. AB - Background. 'Women should have mammograms' is the usual perspective of educational interventions about screening. The perspective that 'women should be informed' about potential risks and benefits so they can make value- and evidence-integrated personal decisions has recently been advocated. However, this perspective has not previously been operationalized. We developed an evidence-based cross-cultural mammography decision aid (MDA), for European American and Mexican American women who are 50-70 years old, at average risk of breast cancer, of varying educational levels, and English- or Spanish-speaking. Methods. MDA development included: (1) content development by a multidisciplinary team and lay women and (2) testing for validity and reliability. Four parts include: (1) introduction; (2) information about logistics (cost, time, discomfort) and risks (sequelae of false-positive or negative results; (3) probability of developing breast cancer; and (4) benefit of mammography regarding breast cancer outcomes (e.g., death and recurrence). We assessed reliability (stability of decisions with the same information) after 1-2 weeks. We assessed validity (comprehension of information) quantitatively (probabilities were changed to see whether preferences changed predictably) and qualitatively (focus groups, standardized probes for comprehension). Subjects were a convenience sample of 49 European American (50-81 years old) and 54 Mexican American (49-89 years old) women from administrative staff at a medical school, the waiting room of an indigent primary care clinic, and a community center. Results. Reliability was 100%. In quantitative validity testing, 22 of 28 women (89%) changed preference as predicted with changed probabilities. Comprehension was confirmed qualitatively in all phases of testing with both Spanish and English versions. Conclusion. The decision aid is valid and reliable in English and Spanish for southwestern Mexican American and European American women at average risk of breast cancer, including those of low educational levels. Copyright 2000 American Health Foundation and Academic Press. SN - 0091-7435 AD - Division of General Medicine, Audie L. Murphy Division/South Texas Veterans Health Care System, San Antonio, TX 78284 U2 - PMID: 10684743. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107110839&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107125317 T1 - Life expectancy gains from cancer prevention strategies for women with breast cancer and BRCA1 or BRCA2 mutations. AU - Schrag D AU - Kuntz KM AU - Garber JE AU - Weeks JC AU - Schrag, D AU - Kuntz, K M AU - Garber, J E AU - Weeks, J C Y1 - 2000/02/02/ N1 - Accession Number: 107125317. Language: English. Entry Date: 20000801. Revision Date: 20161112. Publication Type: journal article; research; tables/charts. Commentary: Wilkins EG. [Commentary on] Life expectancy gains from cancer prevention strategies for women with breast cancer and BRCA1 or BRCA2 mutations. (WOMENS ONCOL REV) 2001 Sep; 1 (3): 315-315; Swanson G P. Benefit of prophylactic mastectomy for women with BRCA1 or BRCA2 mutations. (JAMA) 6/21/2000; 283 (23): 3070-3072. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Grant Information: Supported by a Young Investigator Award from the American Society of Clinical Oncology and a Charles King Fellowship from the Medical Foundation, Boston, Mass and by the Charles H. Dyson Fund. NLM UID: 7501160. KW - Breast Neoplasms -- Prevention and Control KW - Life Expectancy KW - Tamoxifen -- Therapeutic Use KW - Mastectomy KW - Cancer Patients KW - Breast Neoplasms -- Familial and Genetic KW - Oophorectomy KW - Funding Source KW - Breast Neoplasms -- Therapy KW - Female KW - Human SP - 617 EP - 624 JO - JAMA: Journal of the American Medical Association JF - JAMA: Journal of the American Medical Association JA - JAMA VL - 283 IS - 5 CY - Chicago, Illinois PB - American Medical Association AB - Context: Women with BRCA1- or BRCA2-associated breast cancer are at increased risk for contralateral breast cancer and ovarian cancer and therefore may consider secondary cancer prevention strategies, such as prophylactic surgery and tamoxifen therapy. It is not proven to what extent these strategies reduce risk of second cancers in such patients.Objective: To examine the effect of tamoxifen therapy, bilateral prophylactic oophorectomy (PO), prophylactic contralateral mastectomy (PCM), and combinations of these strategies on life expectancy for women with unilateral breast cancer and a BRCA1 or BRCA2 gene mutation.Design and Setting: Decision analysis using a Markov model. Probabilities for developing contralateral breast cancer and ovarian cancer, dying from these cancers, dying from primary breast cancer, and the reduction in cancer incidence and mortality due to prophylactic surgeries and/or tamoxifen were estimated from published studies.Participants: Hypothetical breast cancer patients with BRCA1 or BRCA2 mutations facing decisions about secondary cancer prevention strategies.Interventions: Seven strategies, including 5 years of tamoxifen use, PO, PCM, and combinations of these strategies, compared with careful surveillance.Main Outcome Measures: Total and incremental life expectancy (LE) with each intervention strategy.Results: Depending on the assumed penetrance of the BRCA mutation, compared with surveillance alone, 30-year-old early-stage breast cancer patients with BRCA mutations gain in LE 0.4 to 1.3 years from tamoxifen therapy, 0.2 to 1.8 years from PO, and 0.6 to 2.1 years from PCM. The magnitude of these gains is least for women with low-penetrance mutations (assumed contralateral breast cancer risk of 24% and ovarian cancer risk of 6%) and greatest for those with high-penetrance mutations (assumed contralateral breast cancer risk of 65% and ovarian cancer risk of 40%.) Older age and poorer prognosis from primary breast cancer further attenuate these gains.Conclusions: Interventions to prevent second cancers, particularly PCM, may offer substantial LE gain for young women with BRCA-associated early-stage breast cancer. Estimates of LE gain may help women and their physicians consider the uncertainties, risks, and advantages of these interventions and lead to more informed choices about cancer prevention strategies. SN - 0098-7484 AD - Department of Adult Oncology, Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, Mass, USA AD - Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021 U2 - PMID: 10665701. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107125317&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107099869 T1 - Prevention with tamoxifen or other hormones versus prophylactic surgery in BRCA1/2-positive women: a decision analysis. AU - Grann VR AU - Jacobson JS AU - Whang W AU - Hershman D AU - Heitjan DF AU - Antman KH AU - Neugut AI Y1 - 2000/01//Jan/Feb2000 N1 - Accession Number: 107099869. Language: English. Entry Date: 20070101. Revision Date: 20150711. Publication Type: Journal Article; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. Grant Information: Supported in part by grant number CRTG-98-260-01 from the American Cancer Society, Atlanta, GA, and grant number P30 CA13996-26, Cancer Center Support Grant, NIH/NCI. NLM UID: 9513568. KW - Breast Neoplasms -- Prevention and Control KW - Breast Neoplasms -- Familial and Genetic KW - Mutation KW - Decision Making, Clinical KW - Chemoprevention KW - Quality of Life KW - Breast Neoplasms -- Economics KW - Survival KW - Mastectomy KW - Breast Neoplasms -- Surgery KW - Breast Neoplasms -- Drug Therapy KW - Chemotherapy, Cancer KW - Funding Source SP - 13 EP - 20 JO - Cancer Journal from Scientific American JF - Cancer Journal from Scientific American JA - CANCER J SCI AM VL - 6 IS - 1 CY - Baltimore, Maryland PB - Lippincott Williams & Wilkins AB - PURPOSE: Recent randomized controlled trials have shown that tamoxifen and raloxifene may prevent invasive breast cancer. This decision analysis study compares the outcomes of chemoprevention with tamoxifen, raloxifene, or oral contraceptives with the outcomes of prophylactic surgery among women with high-risk BRCA1/2 mutations. PATIENTS AND METHODS: We used a simulated cohort of 30-year-old women who tested positive for BRCA1/2 mutations and constructed a Markov model with Monte Carlo simulations, incorporating cumulative breast and ovarian cancer incidence rates from the literature and survival figures from SEER data. We assumed that prophylactic surgery reduces ovarian cancer risk by 45% and breast cancer risk by 90%, that tamoxifen reduces invasive breast cancer risk by 49%, and that raloxifene has similar efficacy and safety in premenopausal and postmenopausal women. We used data obtained from high-risk women by a time trade-off questionnaire to calculate quality-adjusted life-years. We based our cost estimates for hospital and ambulatory care on Health Care Financing Administration payments, the SEER-HCFA database, and the Pharmacy Fundamental Reference. RESULTS: In our model, a 30-year-old BRCA1/2+ woman could prolong survival by 0.9 years (95% probability interval, 0.4-1.2 years) by having bilateral oophorectomy, 3.4 years (2.7-3.7 years) by having bilateral mastectomy, and 4.3 years (3.6-4.6 years) by having both procedures instead of surveillance alone. Chemoprevention with tamoxifen and raloxifene increased survival by 1.6 years (1.0-2.1 years) and 2.2 years (1.3-2.8 years), respectively. Chemoprevention yielded more quality-adjusted life-years than did prophylactic surgery, even when treatment was delayed to age 40 or 50 years. All these procedures were cost-effective or cost-saving compared with surveillance alone. DISCUSSION: Our model suggests that although surgery may yield more substantial survival and cost benefits, quality of life issues may make chemoprevention a more attractive option for young women at high genetic risk. SN - 1081-4442 AD - Herbert Irving Comprehensive Cancer Center of Columbia University, PH-18-201A, 630 West 168th St., New York, NY 10032 U2 - PMID: 10696733. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107099869&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107100724 T1 - Continuing screening mammography in women aged 70 to 79 years: impact on life expectancy and cost-effectiveness. AU - Kerlikowske K AU - Salzmann P AU - Phillips KA AU - Cauley JA AU - Cummings SR AU - Kerlikowske, K AU - Salzmann, P AU - Phillips, K A AU - Cauley, J A AU - Cummings, S R Y1 - 1999/12/08/ N1 - Accession Number: 107100724. Language: English. Entry Date: 20000401. Revision Date: 20161112. Publication Type: journal article; research; tables/charts. Commentary: Slawson D. Is screening mammography useful for some women aged 70 years and older? (EVID BASED PRACT) 2000 Mar; 3 (3): 2-3 2p; Mandelblatt J, Yabroff K R, Lawrence W, Yi B, Orosz G, Bloom H G, et al. Screening mammography in elderly women. Research on Breast Cancer in Older Women Consortium. (JAMA) 6/28/2000; 283 (24): 3202-3203. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Grant Information: 1 U01 CA 63740/CA/NCI NIH HHS/United States. NLM UID: 7501160. KW - Mammography KW - Cancer Screening KW - Breast Neoplasms -- Prevention and Control KW - Mammography -- Economics KW - Cost Benefit Analysis KW - Aged KW - Female KW - Human SP - 2156 EP - 2163 JO - JAMA: Journal of the American Medical Association JF - JAMA: Journal of the American Medical Association JA - JAMA VL - 282 IS - 22 CY - Chicago, Illinois PB - American Medical Association AB - Context: Mammography is recommended and is cost-effective for women aged 50 to 69 years, but the value of continuing screening mammography after age 69 years is not known. In particular, older women with low bone mineral density (BMD) have a lower risk of breast cancer and may benefit less from continued screening.Objective: To compare life expectancy and cost-effectiveness of screening mammography in elderly women based on 3 screening strategies.Design: Decision analysis and cost-effectiveness analysis using a Markov model.Patients: General population of women aged 65 years or older.Interventions: The analysis compared 3 strategies: (1) Undergoing biennial mammography from age 65 to 69 years; (2) undergoing biennial mammography from age 65 to 69 years, measurement of distal radial BMD at age 65 years, discontinuing screening at age 69 years in women in the lowest BMD quartile for age, and continuing biennial mammography to age 79 years in those in the top 3 quartiles of distal radius BMD; and (3) undergoing biennial mammography from age 65 to 79 years.Main Outcome Measures: Deaths due to breast cancer averted, life expectancy, and incremental cost-effectiveness ratios.Results: Compared with discontinuing mammography screening at age 69 years, measuring BMD at age 65 years in 10000 women and continuing mammography to age 79 years only in women with BMD in the top 3 quartiles would prevent 9.4 deaths and add, on average, 2.1 days to life expectancy at an incremental cost of $66773 per year of life saved. Continuing mammography to age 79 years in all 10000 elderly women would prevent 1.4 additional breast cancer deaths and add only 7.2 hours to life expectancy at an incremental cost of $117689 per year of life saved compared with only continuing mammography to age 79 years in women with BMD in the top 3 quartiles.Conclusions: This analysis suggests that continuing mammography screening after age 69 years results in a small gain in life expectancy and is moderately cost-effective in those with high BMD and more costly in those with low BMD. Women's preferences for a small gain in life expectancy and the potential harms of screening mammography should play an important role when elderly women are deciding about screening. SN - 0098-7484 AD - Department of Epidemiology and Biostatistics, Department of Veterans Affairs, University of California, San Francisco 94121, USA AD - San Francisco Veterans Affairs Medical Center, General Internal Medicine Section, 111A1, 4150 Clement St, San Francisco, CA 94121 (e-mail: kerliko@itsa.ucsf.edu) U2 - PMID: 10591338. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107100724&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107086174 T1 - Options & decisions. Nurses guiding breast cancer-related decisions: a decision support framework. AU - Stacey CD AU - Jacobsen MJ AU - O'Connor AM Y1 - 1999/11//1999 Nov N1 - Accession Number: 107086174. Language: English. Entry Date: 20000201. Revision Date: 20150818. Publication Type: Journal Article; case study; CEU; exam questions; forms; questionnaire/scale; tables/charts. Journal Subset: Editorial Board Reviewed; Expert Peer Reviewed; Nursing; Peer Reviewed; USA. Instrumentation: Decisional Conflict Scale. NLM UID: 9889728. KW - Decision Making, Patient KW - Breast Neoplasms -- Nursing KW - Breast Neoplasms -- Therapy KW - Oncologic Nursing KW - Conceptual Framework KW - Education, Continuing (Credit) KW - Breast Neoplasms -- Prevention and Control KW - Conflict (Psychology) KW - Support, Psychosocial KW - Needs Assessment KW - Patient Attitudes KW - Scales KW - Interview Guides KW - Q-Sort KW - Teaching Materials KW - Patient Education KW - Middle Age KW - Female SP - 71 EP - 105 JO - Innovations in Breast Cancer Care JF - Innovations in Breast Cancer Care JA - INNOV BREAST CANCER CARE VL - 4 IS - 3 PB - Meniscus Educational Institute SN - 1082-1341 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107086174&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 89170086 T1 - Cost-utility analysis of chemotherapy using paclitaxel, docetaxel, or vinorelbine for patients with anthracycline-resistant breast cancer. AU - Leung, P. P. AU - Tannock, I. F. AU - Oza, A. M. AU - Puodziunas, A. AU - Dranitsaris, G. Y1 - 1999/10//10/1/1999 N1 - Accession Number: 89170086. Language: English. Entry Date: 19991201. Revision Date: 20170424. Publication Type: journal article. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Instrumentation: Profile of Mood States (POMS); Clinical Decision Making in Nursing Scale (CDMNS) (Jenkins); Ferrans and Powers Quality of Life Index; Longitudinal Interval Follow-Up Evaluation (LIFE); Craig Handicap Assessment and Reporting Technique (CHART). NLM UID: 8309333. KW - Vinblastine -- Analogs and Derivatives KW - Health Care Costs -- Statistics and Numerical Data KW - Paclitaxel -- Economics KW - Hydrocarbons KW - Paclitaxel -- Analogs and Derivatives KW - Breast Neoplasms -- Drug Therapy KW - Antineoplastic Agents -- Economics KW - Quality-Adjusted Life Years KW - Adult KW - Drug Resistance, Neoplasm KW - Cost Benefit Analysis KW - Paclitaxel -- Therapeutic Use KW - Middle Age KW - Disease Progression KW - Vinblastine -- Economics KW - Breast Neoplasms -- Economics KW - Survival Analysis KW - Antibiotics, Antineoplastic -- Therapeutic Use KW - Antineoplastic Agents -- Therapeutic Use KW - Vinblastine -- Therapeutic Use KW - Human KW - Aged KW - Female KW - Validation Studies KW - Comparative Studies KW - Evaluation Research KW - Multicenter Studies KW - Ferrans and Powers Quality of Life Index KW - Scales SP - 3082 EP - 3090 JO - Journal of Clinical Oncology JF - Journal of Clinical Oncology JA - J CLIN ONCOL VL - 17 IS - 10 CY - Alexandria, Virginia PB - American Society of Clinical Oncology AB - Purpose: Paclitaxel, docetaxel, and vinorelbine have been approved for chemotherapy in patients with advanced breast cancer that is resistant to anthracyclines. Selecting which agent to use is difficult because each possesses advantages and disadvantages related to clinical response, toxicity, method of administration, and cost. A cost-utility analysis was therefore performed to create a rank order on the basis of effectiveness, quality of life, and economic considerations. Patients and Methods: Eighty-eight anthracycline-resistant breast cancer patients who had received paclitaxel (n = 34), docetaxel (n = 29), or vinorelbine (n = 25) during the past 2 years were identified. Total resource consumption was collected, which included expenditures for chemotherapy, supportive care, laboratory tests, management of adverse effects, and all related physician fees. Utilities from 25 oncology care providers and 25 breast cancer patients were estimated using the time trade-off technique. The economic estimates from the chart review and clinical data from the literature were then modeled using the principles of decision analysis. Results: Each of the three drugs led to a similar duration of quality-adjusted progression-free survival (paclitaxel, 37.2 days; docetaxel, 33.6 days; vinorelbine, 38.0 days). Vinorelbine was the least costly strategy, with an overall treatment expenditure of Can $3,259 per patient, compared with Can $6,039 and Can $10,090 for paclitaxel and docetaxel, respectively. Conclusion: Palliative chemotherapy with vinorelbine in anthracycline-resistant metastatic breast cancer patients has economic advantages over the taxanes and provides at least equivalent quality-adjusted progression-free survival. These benefits are largely related to its lower drug acquisition cost and better toxicity profile. SN - 0732-183X AD - Departments of Pharmaceutical Services and Medical Oncology, Ontario Cancer Institute/Princess Margaret Hospital, Toronto, Ontario, Canada U2 - PMID: 10506603. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=89170086&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107083025 T1 - Participation in treatment decision-making by women with early stage breast cancer. AU - Kenny P AU - Quine S AU - Shiell A AU - Cameron S Y1 - 1999/09// N1 - Accession Number: 107083025. Language: English. Entry Date: 20081219. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Europe; Health Services Administration; Peer Reviewed; UK & Ireland. NLM UID: 9815926. KW - Breast Neoplasms -- Therapy KW - Consumer Participation KW - Decision Making, Patient KW - Qualitative Studies KW - Semi-Structured Interview KW - Thematic Analysis KW - Physician-Patient Relations KW - Accountability KW - Access to Information KW - Adult KW - Middle Age KW - Aged KW - Aged, 80 and Over KW - Female KW - Human SP - 159 EP - 168 JO - Health Expectations JF - Health Expectations JA - HEALTH EXPECTATIONS VL - 2 IS - 3 CY - Malden, Massachusetts PB - Wiley-Blackwell AB - Objective This study aimed to assess the way women treated for early stage breast cancer perceived the treatment selection process. The purpose was to understand more fully patients' experiences of the decision process and their preferences for participation in treatment decisions. Setting and participants The study informants were 40 women, treated at a teaching hospital in Sydney Australia, who were interviewed face to face 1 year after their first treatment for stage I or stage II breast cancer. Methods This study used a qualitative approach, based on the analysis of interview transcripts. The main areas covered were how the informants' treatment decisions were made and their preferences for participation in treatment decisions. Content and thematic analyses were conducted with findings presented using verbatim quotations for illustration. Results and conclusions Many of the informants who preferred not to participate in decisions also failed to recognize the need for value judgements (as well as medical expertise) in the decision-making process. Some informants believed they ought to be responsible for the consequences whilst others did not. Difficulties were identified in patient utilization of medical information for treatment decision-making, and also in establishing preferences for the risks and benefits of treatments where few patients had prior experience of the potential outcomes. The findings indicate that patient participation in treatment decision-making is a more complex issue than simply giving patients information and choices. Ways of enhancing patients' involvement in the treatment selection process are discussed. SN - 1369-6513 AD - Centre for Health Economics Research and Evaluation (CHERE), University of Sydney, Level 6 Building F, 88 Mallett St, Camperdown NSW 2050, Australia; email patsyk@chere.usyd.edu.au UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107083025&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107215571 T1 - Breast cancer survivors' perceptions of complementary/alternative medicine (CAM): making the decision to use or not to use. AU - Boon H AU - Brown JB AU - Gavin A AU - Kennard MA AU - Stewart M Y1 - 1999/09// N1 - Accession Number: 107215571. Language: English. Entry Date: 19991001. Revision Date: 20150820. Publication Type: Journal Article; research; tables/charts. Journal Subset: Core Nursing; Nursing; Peer Reviewed; USA. Grant Information: Funded by a grant from the Canadian Breast Cancer Research Initiative. NLM UID: 9202144. KW - Alternative Therapies -- Utilization KW - Cancer Survivors KW - Decision Making, Patient KW - Breast Neoplasms -- Therapy KW - Funding Source KW - Focus Groups KW - Exploratory Research KW - Feminist Critique KW - Women's Health KW - Adult KW - Middle Age KW - Aged KW - Female KW - Human SP - 639 EP - 653 JO - Qualitative Health Research JF - Qualitative Health Research JA - QUAL HEALTH RES VL - 9 IS - 5 CY - Thousand Oaks, California PB - Sage Publications Inc. AB - The study described in this article explored breast cancer survivors' perceptions and experiences as they decided whether to use a variety of complementary/alternative therapies. Six focus groups were conducted composed of women who had been diagnosed with breast cancer. Each 2-hour session was audiotaped and transcribed verbatim. In this article, the process by which the participants made the decision to use or not to use complementary/alternative therapies, including their discovery and investigation of complementary/alternative medicine (CAM) and their experiences using or not using CAM, are described. Barriers to using CAM included cost, access, and time. Family and friends generally supported the decision to use CAM, however, the participants described health care practitioners' reactions as mixed. SN - 1049-7323 AD - Centre for Studies in Family Medicine, Department of Family Medicine, University of Western Ontario, School of Social Work, Kings College, London, Ontario, Canada U2 - PMID: 10558372. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107215571&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107011492 T1 - Offering a choice between two adjuvant chemotherapy regimens: pilot study to develop a decision aid for women with breast cancer. AU - Irwin E AU - Arnold A AU - Whelan TJ AU - Reyno LM AU - Cranton P Y1 - 1999/07//1999 Jul N1 - Accession Number: 107011492. Language: English. Entry Date: 20010330. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Core Nursing; Europe; Health Promotion/Education; Nursing; Peer Reviewed; UK & Ireland. Grant Information: Supported by The Canadian Breast Cancer Foundation (Fellowship Fund). NLM UID: 8406280. KW - Breast Neoplasms -- Drug Therapy KW - Chemotherapy, Adjuvant KW - Decision Making, Patient -- Methods KW - Pilot Studies KW - Female KW - Instrument Construction KW - Questionnaires KW - Pretest-Posttest Design KW - Descriptive Statistics KW - Chi Square Test KW - Adult KW - Middle Age KW - Outpatients KW - Funding Source KW - Human SP - 283 EP - 291 JO - Patient Education & Counseling JF - Patient Education & Counseling JA - PATIENT EDUC COUNS VL - 37 IS - 3 PB - Elsevier B.V. SN - 0738-3991 AD - McMaster University, School of Nursing, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada U2 - PMID: 14528554. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107011492&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105972292 T1 - Cost of managing anemia with and without prophylactic epoetin alfa therapy in breast cancer patients receiving combination chemotherapy. AU - Meadowcroft AM AU - Gilbert CJ AU - Maravich-May D AU - Hayward SL Y1 - 1998/09/15/1998 Sep 15 N1 - Accession Number: 105972292. Language: English. Entry Date: 20080215. Revision Date: 20150711. Publication Type: Journal Article; clinical trial; research. Journal Subset: Biomedical; Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 9503023. KW - Anemia -- Economics KW - Antineoplastic Agents, Combined -- Adverse Effects KW - Breast Neoplasms -- Economics KW - Erythropoietin -- Economics KW - Hematinics -- Economics KW - Anemia -- Drug Therapy KW - Anemia -- Etiology KW - Antineoplastic Agents, Combined -- Therapeutic Use KW - Blood Component Transfusion -- Economics KW - Breast Neoplasms -- Drug Therapy KW - Clinical Trials KW - Decision Trees KW - Erythropoietin -- Therapeutic Use KW - Fatigue -- Etiology KW - Female KW - Hematinics -- Therapeutic Use KW - Medline KW - Retrospective Design KW - Human SP - 1898 EP - 1902 JO - American Journal of Health-System Pharmacy JF - American Journal of Health-System Pharmacy JA - AM J HEALTH SYST PHARM AJHP VL - 55 IS - 18 CY - Bethesda, Maryland PB - American Society of Health System Pharmacists AB - The cost of managing anemia with prophylactic epoetin alfa therapy versus blood transfusions in breast cancer patients receiving combination chemotherapy was studied. A retrospective study of anemia in breast cancer patients treated with four cycles of cyclophosphamide and doxorubicin with fluorouracil (CAF) or without fluorouracil (CA) was conducted. For each cycle of chemotherapy, patients were assessed for fatigue, subsequent blood transfusions administered, and potential response to and adverse effects of blood transfusions. Transfusions were given at the prescriber's discretion rather than in accordance with standard guidelines. The lowest hemoglobin concentration and hematocrit of each patient per cycle were reported. Data on these patients, along with data from published studies of prophylactic use of epoetin alfa, were used in a decision analysis of the costs associated with using epoetin alfa versus red blood cell transfusions to manage anemia. The charts of 50 patients were reviewed. In the study group, the percentage of patients with anemia and the frequency of fatigue rose with each chemotherapy cycle. In general, blood transfusions were not used. The cost of using epoetin alfa prophylactically for all four cycles was estimated at $6483 per patient for the literature-based group versus $169 for the study group. The cost of managing anemia in breast cancer patients was substantially lower when blood transfusions were used than when epoetin alfa was given prophylactically throughout four cycles of therapy with CAF or CA; the absence of standard guidelines for transfusion might have exaggerated the difference in costs. SN - 1079-2082 U2 - PMID: 9784769. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105972292&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107284585 T1 - Domains of distress: the experience of breast cancer in Australia. AU - Steginga S AU - Occhipinti S AU - Wilson K AU - Dunn J Y1 - 1998/07//1998 Jul N1 - Accession Number: 107284585. Language: English. Entry Date: 19981001. Revision Date: 20150819. Publication Type: Journal Article; research; tables/charts. Journal Subset: Core Nursing; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Nursing; Peer Reviewed; USA. Instrumentation: Rotterdam Symptom Checklist (RSCL) (De Haes et al). Grant Information: Supported by the Queensland Cancer Fund. NLM UID: 7809033. KW - Breast Neoplasms -- Psychosocial Factors KW - Funding Source KW - Australia KW - Descriptive Research KW - Exploratory Research KW - Questionnaires KW - Factor Analysis KW - Qualitative Studies KW - Mail KW - Instrument Construction KW - Descriptive Statistics KW - Multiple Regression KW - Convenience Sample KW - Cancer Patients KW - Adult KW - Middle Age KW - Aged KW - Female KW - Human SP - 1063 EP - 1070 JO - Oncology Nursing Forum JF - Oncology Nursing Forum JA - ONCOL NURS FORUM VL - 25 IS - 6 CY - Pittsburgh, Pennsylvania PB - Oncology Nursing Society AB - PURPOSE/OBJECTIVES: To describe difficulties experienced by women after treatment for primary breast cancer. DESIGN: Descriptive and exploratory. SETTING: Queensland, Australia. SAMPLE: 245 women (70% response rate) less than 16 weeks postsurgery for breast cancer completed a survey. The mean age for this sample was 55 years; 71% had undergone mastectomy, and 29% had undergone conservative breast surgery. METHODS: Focus groups were used to generate items for the survey, 'Experience of Breast Cancer Questionnaire' (EBCQ). The EBCQ and the psychological subscale of the Rotterdam Symptom Checklist (RSCL) were administered by mail to the sample. MAIN RESEARCH VARIABLES: Psychological distress, fear of recurrence, decisional uncertainty, informational support, self-image and social relationships, sexual morbidity, and physical effects of treatments. FINDINGS: Factor analysis of the EBCQ identified five factors, accounting for 60% of the variance. These included psychological effects, treatment concerns, physical effects, self-image, and chemotherapy effects. Four of the five subscales had reliability coefficients of greater than 0.80. Psychological effects included cognitive and emotional effects. Treatment concerns included decisional uncertainty and poorly perceived informational support. Physical effects reflected the symptom pattern of axillary dissection. Self-image included breast loss and social isolation. CONCLUSIONS: Nurses who assist women in adjusting to breast cancer should consider the effect of fear of recurrence and perceptions of body image on the recovery process. Because participation in treatment decisions may increase the demands on women at diagnosis, informational support appropriate to each woman's needs is essential. How self-esteem can affect self-image and social relationships after breast cancer requires further investigation. IMPLICATIONS FOR NURSING PRACTICE: Understanding the experience of illness from the perspective of the patient assists nurses in validating their nursing practice and provides clinically relevant information to guide intervention. In particular, supportive psychological care should target both emotional and cognitive responses to breast cancer. Informational support is integral to a patient's satisfaction with treatment decisions and is likely to predict adjustment. When assisting women to adjust to self-image changes, nurses may need to target women's perceptions about their body image. SN - 0190-535X AD - Australian Catholic University, Brisbane, Queensland, Australia U2 - PMID: 9679264. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107284585&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107203852 T1 - Development of a patient decision aid for choice of surgical treatment for breast cancer. AU - Sawka CA AU - Goel V AU - Mahut CA AU - Taylor GA AU - Thiel EC AU - O'Connor AM AU - Ackerman I AU - Burt JH AU - Gort EH Y1 - 1998/06// N1 - Accession Number: 107203852. Language: English. Entry Date: 20070101. Revision Date: 20150711. Publication Type: Journal Article; questionnaire/scale; research; tables/charts. Journal Subset: Europe; Health Services Administration; Peer Reviewed; UK & Ireland. Instrumentation: Decisional Conflict Scale (DCS); Breast Cancer Information Test (BCIT). Grant Information: Supported by the Institute for Clinical Evaluative Sciences, Ontario. NLM UID: 9815926. KW - Decision Making, Patient KW - Breast Neoplasms -- Surgery KW - Mastectomy -- Psychosocial Factors KW - Information Needs KW - Pilot Studies KW - Needs Assessment KW - Questionnaires KW - Research Instruments KW - Audiorecording KW - Adult KW - Middle Age KW - Aged KW - Female KW - Funding Source KW - Human SP - 23 EP - 36 JO - Health Expectations JF - Health Expectations JA - HEALTH EXPECTATIONS VL - 1 IS - 1 CY - Malden, Massachusetts PB - Wiley-Blackwell AB - Purpose: A patient decision aid for the surgical treatment of early stage breast cancer was developed and evaluated. The rationale for its development was the knowledge that breast conserving therapy (lumpectomy followed by breast radiation) and mastectomy produce equivalent outcomes, and the current general agreement that the decision for the type of surgery should rest with the patient. Methods: A decision aid was developed and evaluated in sequential pilot studies of 18 and 10 women with newly diagnosed breast cancer who were facing a decision for breast conserving therapy or mastectomy. Both qualitative (general reaction. self-reported anxiety. clarity, satisfaction) and quantitative (knowledge and decisional conflict) measures were assessed. Results: The decision aid consists of an audiotape and workbook and takes 36 min to complete. Based on qualitative comments and satisfaction ratings, 17 of 18 women reported a positive reaction to the decision aid and all 18 reported that it helped clarify information given by the surgeon. Women did not report an increase in anxiety and 17 of 18 women were either satisfied or very satisfied with the decision aid. Conclusion: This pilot study supports the hypothesis that this decision aid may be a helpful adjunct in the decision for surgical management of early stage breast cancer. We are currently conducting a randomized trial of the decision aid versus a simple educational pamphlet to evaluate its efficacy as measured by knowledge, decisional conflict, anxiety and post-decisional regret. SN - 1369-6513 AD - Division of Medical Oncology/Hematology, Toronto-Sunnybrook Regional Cancer Centre, 2075 Bayview Ave., Toronto, Ontario M4N 3M5, Canada; e-mail: carol_sawka@cancercare.on.ca UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107203852&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107176518 T1 - Role of the breast care clinical nurse specialist in facilitating decision-making for treatment choice: a practice profile. AU - Carroll S Y1 - 1998/03//1998 Mar N1 - Accession Number: 107176518. Language: English. Entry Date: 19990401. Revision Date: 20150819. Publication Type: Journal Article; research; tables/charts. Journal Subset: Core Nursing; Europe; Nursing; Peer Reviewed; UK & Ireland. NLM UID: 100885136. KW - Clinical Nurse Specialists -- United Kingdom KW - Oncologic Nursing -- United Kingdom KW - Decision Making, Clinical KW - Breast Neoplasms KW - Qualitative Studies KW - Descriptive Research KW - Observational Methods KW - Theoretical Sample KW - Semi-Structured Interview KW - Questionnaires KW - Thematic Analysis KW - Qualitative Validity KW - United Kingdom KW - Nursing Role KW - Decision Making, Patient KW - Human SP - 34 EP - 42 JO - European Journal of Oncology Nursing JF - European Journal of Oncology Nursing JA - EUR J ONCOL NURS VL - 2 IS - 1 PB - Churchill Livingstone, Inc. AB - Recently, the Breast Care Clinical Nurse Specialist (CNS) role has incorporated facilitating decision-making for breast cancer patients. Contemporary breast cancer is experienced as a complex paradigm of choice involving multiple options and a variety of possible outcomes of substantial uncertainty. This project, using a practice profile approach, endeavours to highlight that the Breast Care CNS's role in providing this decisional support must be developed and evaluated. A practice profile allows examination of an area of practice in some depth. In this case, the methodology used adopted a qualitative, descriptive approach using interviews, observations and a demographic questionnaire. The profile indicates that 40% of the role is spent on this area. The profile suggests that facilitation occurs in different stages, that structural/contextual factors may influence this and that Breast Care CNSs generally find this area of care stressful in terms of striving for a neutral role and ascertaining what the patient really wants. Implications and recommendations are highlighted that emphasize the importance of developing this role; a role which will become more challenging as treatment choice becomes more complex. SN - 1462-3889 AD - Royal Marsden Hospital, Downs Road, Sutton, Surrey, UK UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107176518&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - THES ID - 109877837 T1 - Decision-making and genetic testing for breast cancer: a grounded theory analysis. AU - Pfeifer KAB Y1 - 1998/01// N1 - Accession Number: 109877837. Language: English. Entry Date: 20040723. Revision Date: 20150923. Publication Type: Doctoral Dissertation; research. KW - Breast Neoplasms -- Familial and Genetic KW - Breast Neoplasms -- Prevention and Control KW - Decision Making, Patient KW - Genetic Screening -- Psychosocial Factors KW - Adult KW - Aged KW - Descriptive Research KW - Descriptive Statistics KW - Exploratory Research KW - Female KW - Grounded Theory KW - Interviews KW - Middle Age KW - Purposive Sample KW - Theory Construction KW - Human SP - 214 p EP - 214 p JO - Decision-making & Genetic Testing for Breast Cancer: A Grounded Theory Analysis JF - Decision-making & Genetic Testing for Breast Cancer: A Grounded Theory Analysis PB - Texas Woman's University AB - The purpose of this study was to qualitatively explore and describe the decision-making process of women facing genetic testing for breast cancer. Specific aims included: (a) to describe and explain the emerging concepts and domains associated with the phenomenon of decision-making and genetic testing for breast cancer and (b) to initiate the development of a model of this phenomenon.Using purposive and theoretical sampling, 12 women aged 34 to 74 years were interviewed over 8 months regarding their decisions about genetic testing for breast cancer. The participants were predominantly Caucasian (100%), married (92%) and Protestant (75%). Of the 12 women, four (33%) were breast cancer survivors. At the time of the interviews, 11 women (92%) had made their decision about genetic testing.Data analysis was conducted using the method of grounded theory first introduced by Glaser and Strauss (1967). Among the many patterns evident in the abundant data, six distinct yet related categories emerged. The categories were Barriers, Altruism, Seeking Answers, Ownership of Decision, Comparing Stories and Controlling Destiny. These six categories were further reduced to three domains: (a) Information (composed of Comparing Stories and Seeking Answers), (b) Relationship (composed of Altruism and Ownership of Decision) and (c) Coping (composed of Barriers and Controlling Destiny).The overriding goal for the women interviewed was that of coming to terms with breast cancer. This goal was supported through the interactive processes accomplished in the Information, Relationship and Coping Domains. The women's level of uncertainty about breast cancer guided the amount of work to be accomplished in each of the three domains and, thus, the length of time spent at that level of the decision-making process. Successful processing in the three domains supported the women's ability to come to terms with breast cancer. They were then able to make a decision about genetic testing and act on it. Any unresolved tensions in the three domains prohibited the women from successfully coming to terms with breast cancer and, ultimately, deciding about genetic testing. SN - 9780591973198 AV - UMI Order AAI9900366 M1 - Ph.D. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109877837&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105824186 T1 - Risk of breast cancer in carriers of BRCA gene mutations. AU - Orlando R 3rd Y1 - 1997/09/11/ N1 - Accession Number: 105824186. Language: English. Entry Date: 20080307. Revision Date: 20150711. Publication Type: Journal Article; commentary; letter; response. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 0255562. KW - Breast Neoplasms -- Prevention and Control KW - Decision Support Techniques KW - Ovarian Neoplasms -- Prevention and Control KW - Breast Neoplasms KW - Female KW - Genes, BRCA KW - Life Expectancy KW - Mastectomy KW - Mutation KW - Oophorectomy KW - Ovarian Neoplasms KW - Proteins SP - 787 EP - 789 JO - New England Journal of Medicine JF - New England Journal of Medicine JA - N ENGL J MED VL - 337 IS - 11 CY - Waltham, Massachusetts PB - New England Journal of Medicine SN - 0028-4793 U2 - PMID: 9289637. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105824186&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105824187 T1 - Risk of breast cancer in carriers of BRCA gene mutations. AU - Birkmeyer JD AU - Welch HG Y1 - 1997/09/11/ N1 - Accession Number: 105824187. Language: English. Entry Date: 20080307. Revision Date: 20150711. Publication Type: Journal Article; commentary; letter; response. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 0255562. KW - Breast Neoplasms -- Prevention and Control KW - Life Expectancy KW - Ovarian Neoplasms -- Prevention and Control KW - Breast Neoplasms KW - Decision Support Techniques KW - Female KW - Genes, BRCA KW - Mastectomy KW - Mutation KW - Oophorectomy KW - Ovarian Neoplasms KW - Proteins SP - 787 EP - 789 JO - New England Journal of Medicine JF - New England Journal of Medicine JA - N ENGL J MED VL - 337 IS - 11 CY - Waltham, Massachusetts PB - New England Journal of Medicine SN - 0028-4793 U2 - PMID: 9289638. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105824187&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105824188 T1 - Risk of breast cancer in carriers of BRCA gene mutations. AU - Meijer WJ AU - van Lindert AC Y1 - 1997/09/11/ N1 - Accession Number: 105824188. Language: English. Entry Date: 20080307. Revision Date: 20150711. Publication Type: Journal Article; commentary; letter; response. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 0255562. KW - Breast Neoplasms -- Prevention and Control KW - Oophorectomy KW - Decision Support Techniques KW - Female KW - Life Expectancy KW - Mastectomy KW - Models, Theoretical KW - Relative Risk SP - 788 EP - 789 JO - New England Journal of Medicine JF - New England Journal of Medicine JA - N ENGL J MED VL - 337 IS - 11 CY - Waltham, Massachusetts PB - New England Journal of Medicine SN - 0028-4793 U2 - PMID: 9289640. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105824188&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105824189 T1 - Risk of breast cancer in carriers of BRCA gene mutations. AU - Grann V Y1 - 1997/09/11/ N1 - Accession Number: 105824189. Language: English. Entry Date: 20080307. Revision Date: 20150711. Publication Type: Journal Article; commentary; letter. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 0255562. KW - Decision Support Techniques KW - Breast Neoplasms -- Prevention and Control KW - Female KW - Relative Risk SP - 788 EP - 788 JO - New England Journal of Medicine JF - New England Journal of Medicine JA - N ENGL J MED VL - 337 IS - 11 CY - Waltham, Massachusetts PB - New England Journal of Medicine SN - 0028-4793 U2 - PMID: 9289639. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105824189&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107264268 T1 - Australian economic evaluation and government decisions on pharmaceuticals, compared to assessment of other health technologies. AU - Hailey D Y1 - 1997/08/15/ N1 - Accession Number: 107264268. Language: English. Entry Date: 19980601. Revision Date: 20150711. Publication Type: Journal Article; tables/charts. Journal Subset: Allied Health; Biomedical; Continental Europe; Double Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed. NLM UID: 8303205. KW - Economics, Pharmaceutical -- Australia KW - Health Policy -- Economics -- Australia KW - National Health Programs -- Australia KW - Australia KW - Drug Utilization -- Economics -- Australia KW - Cost Benefit Analysis KW - Cancer Screening KW - Breast Neoplasms -- Prevention and Control KW - Cervix Neoplasms -- Prevention and Control KW - Organ Transplantation -- Trends KW - Magnetic Resonance Imaging -- Trends KW - Lithotripsy -- Trends SP - 563 EP - 581 JO - Social Science & Medicine JF - Social Science & Medicine JA - SOC SCI MED VL - 45 IS - 4 PB - Pergamon Press - An Imprint of Elsevier Science AB - In this paper the first theme is the experience with the routine use of cost-effectiveness analysis in decisions by the Australian Pharmaceutical Benefits Advisory Committee on whether drug products should attract a government subsidy. As a second theme, the contrasting experience with several other health technologies is presented, with economic analysis being less frequently used in a system where there is a weaker regulatory framework. Some general points that emerge in both areas are the importance of factors other than economic evaluation in the decision-making process, and the need to make policy and administrative decisions on the basis of limited data. There is limited material available in the public domain on the interaction of economic evaluation and Australian policy on health technologies. It has been necessary, particularly in relation to the case studies presented here, to rely on input from discussion with a number of individuals and on observations made during personal involvement with some of the assessments. It is not possible to offer substantive evidence in support of this material, and indeed firm evidence in the area of impact of assessments on health policy remains difficult to collect. SN - 0277-9536 AD - Centre for Health Program Evaluation, Fairfield Hospital, Melbourne, Australia U2 - PMID: 9226782. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107264268&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 104796372 T1 - Breast cancer screening in younger women: evidence and decision making. AU - Elwood, J M Y1 - 1997/08// N1 - Accession Number: 104796372. Language: English. Entry Date: 20110610. Revision Date: 20150711. Publication Type: Journal Article. Journal Subset: Biomedical; Blind Peer Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; Public Health; UK & Ireland. NLM UID: 9609066. KW - Breast Neoplasms -- Prevention and Control KW - Medical Practice, Evidence-Based KW - Mammography KW - Patient Selection KW - Adult KW - Age Factors KW - Cost Benefit Analysis KW - Female KW - Health Policy KW - Middle Age KW - Politics KW - United States SP - 179 EP - 186 JO - Journal of Evaluation in Clinical Practice JF - Journal of Evaluation in Clinical Practice JA - J EVAL CLIN PRACT VL - 3 IS - 3 CY - Malden, Massachusetts PB - Wiley-Blackwell AB - Contrasting conclusions on the efficacy of routine breast cancer screening in younger women, under age 50, have been produced by expert and influential groups, particularly in the United States. In an international workshop in 1993, and again at a consensus development conference in 1997, the National Institutes of Health and the National Cancer Institute concluded that evidence for efficacy was uncertain, and routine screening could not be recommended. The 1997 conference concluded that the individual decision had to be made by each woman and her health care provider. In contrast, the American Cancer Society has advocated routine screening, despite accepting that the randomized trial evidence does not clearly support it. The decision of the 1997 NCI consensus conference has been rejected by the director of the NCI, and a similar controversy occurred in 1993. On two occasions, US Senate subcommittees have affirmed support for screening and criticized the conclusions of expert groups. In this paper, the arguments raised in these discussions, and the differing ways in which scientific evidence has been assessed, are discussed. SN - 1356-1294 AD - Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand. U2 - PMID: 9406105. DO - 10.1046/j.1365-2753.1997.00002.x UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104796372&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107251844 T1 - The costs and effects of cervical and breast cancer screening in a public hospital emergency room. AU - Mandelblatt J AU - Freeman H AU - Winczewski D AU - Cagney K AU - Williams S AU - Trowers R AU - Tang J AU - Gold K AU - Lin TH AU - Kerner J Y1 - 1997/07// N1 - Accession Number: 107251844. Language: English. Entry Date: 19980401. Revision Date: 20150711. Publication Type: Journal Article; algorithm; research; tables/charts. Journal Subset: Biomedical; Core Nursing; Double Blind Peer Reviewed; Nursing; Peer Reviewed; Public Health; USA. Grant Information: Supported by National Cancer Institute grant R01 CA 50520. NLM UID: 1254074. KW - Cancer Screening -- Economics KW - Cervical Smears KW - Breast Neoplasms -- Prevention and Control KW - Hospital Programs -- Evaluation KW - Cervix Neoplasms -- Prevention and Control KW - Emergency Service -- Administration KW - Emergency Service -- Economics KW - Evaluation Research KW - Probability KW - Outcomes Research KW - Record Review KW - Descriptive Statistics KW - Cost Benefit Analysis KW - Neoplasm Staging KW - National Cancer Institute (U.S.) KW - After Care KW - Minority Groups KW - Hospitals, Public KW - Adult KW - Middle Age KW - Aged KW - Male KW - Funding Source KW - Human SP - 1182 EP - 1189 JO - American Journal of Public Health JF - American Journal of Public Health JA - AM J PUBLIC HEALTH VL - 87 IS - 7 CY - Washington, District of Columbia PB - American Public Health Association AB - OBJECTIVES: This study assessed the cost-effectiveness of cervix and breast cancer screening in a public hospital emergency room. METHODS: Age-eligible women with nonurgent conditions and without recent screening were offered screening by a nurse. A decision analysis compared the costs and outcomes of emergency room screening and standard hospital screening efforts. RESULTS: The undiscounted cost-effectiveness results for establishing new programs were $4050 (cervical cancer), $403,203 (breast cancer), and $4375 (joint cervix and breast cancer) per year of life saved. If screening is added to an existing program, results are more favorable ($429, $21,324, and $479 per year of life saved for cervix, breast, and joint screening, respectively). Results were most sensitive to volume and probability of receiving treatment after an abnormal screen. CONCLUSIONS: Emergency room screening was cost-effective for cervical cancer; breast cancer screening was relatively expensive given the low number of women reached. More intensive recruitment and follow-up strategies are needed to maximize the cost-effectiveness of such programs. SN - 0090-0036 AD - Department of Epidemiology and Biostatistics, Memorial-Sloan-Kettering Cancer Center, New York City U2 - PMID: 9240110. DO - 10.2105/AJPH.87.7.1182 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107251844&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107232748 T1 - Factors that influence plastic surgeons' advice about reconstruction to women with breast cancer. AU - Neill KM AU - Briefs BA Y1 - 1997///1997 Summer N1 - Accession Number: 107232748. Language: English. Entry Date: 19980101. Revision Date: 20150819. Publication Type: Journal Article; research; tables/charts. Journal Subset: Core Nursing; Nursing; Peer Reviewed; USA. Grant Information: Funded in part by a grant from the Office of Research and Graduate Education, Georgetown University Medical Center. NLM UID: 8403490. KW - Breast Neoplasms -- Surgery KW - Breast Reconstruction KW - Surgeons KW - Funding Source KW - Descriptive Statistics KW - Pilot Studies KW - Qualitative Studies KW - Interviews KW - Audiorecording KW - Data Analysis Software KW - Thematic Analysis KW - Age Factors KW - Exploratory Research KW - Decision Making, Patient KW - Physician Attitudes KW - Cancer Patients KW - Male KW - Female KW - Human SP - 61 EP - 67 JO - Plastic Surgical Nursing JF - Plastic Surgical Nursing JA - PLAST SURG NURS VL - 17 IS - 2 CY - Baltimore, Maryland PB - Lippincott Williams & Wilkins AB - The purpose of this pilot study was to describe the factors that influence the advice of plastic surgeons who offer reconstructive surgery to women with breast cancer. Answers to the following question were sought: What anatomical, technical, and personal factors are considered by plastic surgeons in their recommendations for reconstruction to women with breast cancer? Five themes emerged that explained approaches used with these patients: (1) technical issues and challenges, (2) patient-centered challenges, (3) aids to patient decision-making, (4) illusion of no loss, and (5) age. SN - 0741-5206 AD - Nursing Director, Clinical Research Center, Georgetown University Medical Center, Washington, DC U2 - PMID: 9275783. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107232748&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107266655 T1 - Patient-specific decisions about hormone replacement therapy in postmenopausal women. AU - Col NF AU - Eckman MH AU - Karas RH AU - Pauker SG AU - Goldberg RJ AU - Ross EM AU - Orr RK AU - Wong JB AU - Col, N F AU - Eckman, M H AU - Karas, R H AU - Pauker, S G AU - Goldberg, R J AU - Ross, E M AU - Orr, R K AU - Wong, J B Y1 - 1997/04/09/ N1 - Accession Number: 107266655. Language: English. Entry Date: 19980601. Revision Date: 20161112. Publication Type: journal article; research; tables/charts. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Grant Information: 1 PO1 HS 06503/HS/AHRQ HHS/United States. NLM UID: 7501160. KW - Hormone Replacement Therapy KW - Decision Making, Computer Assisted KW - Decision Making, Clinical KW - Female KW - Hormone Replacement Therapy -- Adverse Effects KW - Hip Fractures -- Epidemiology KW - Life Expectancy KW - Risk Factors KW - Models, Statistical KW - Middle Age KW - Postmenopause KW - Breast Neoplasms -- Epidemiology KW - Sensitivity and Specificity KW - Relative Risk KW - Confidence Intervals KW - Regression KW - Endometrial Neoplasms -- Epidemiology KW - Coronary Disease -- Epidemiology KW - Incidence KW - Funding Source KW - Human SP - 1140 EP - 1147 JO - JAMA: Journal of the American Medical Association JF - JAMA: Journal of the American Medical Association JA - JAMA VL - 277 IS - 14 CY - Chicago, Illinois PB - American Medical Association AB - Objective: To examine the effect of hormone replacement therapy on life expectancy in postmenopausal women with different risk profiles for heart disease, breast cancer, and hip fracture.Design: Decision analysis using a Markov model. Published regression models were used to link risk factors to disease incidence and to estimate the lifetime risks of developing coronary heart disease (CHD), breast cancer, hip fracture, and endometrial cancer. The impact of hormone therapy on disease incidence was estimated from published epidemiologic studies.Setting: Mathematical model applicable to primary care.Interventions: Treatment with hormone replacement therapy or no hormone replacement therapy.Main Outcome Measure: Life expectancy.Results: Hormone replacement therapy should increase life expectancy for nearly all postmenopausal women, with some gains exceeding 3 years, depending mainly on an individual's risk factors for CHD and breast cancer. For women with at least 1 risk factor for CHD, hormone therapy should extend life expectancy, even for women having first-degree relatives with breast cancer. Women without any risk factors for CHD or hip fracture, but who have 2 first-degree relatives with breast cancer, however, should not receive hormone therapy.Conclusions: The benefit of hormone replacement therapy in reducing the likelihood of developing CHD appears to outweigh the risk of breast cancer for nearly all women in whom this treatment might be considered. Our analysis supports the broader use of hormone replacement therapy. SN - 0098-7484 AD - Division of Clinical Decision Making, Informatics, and Telemedicine, Department of Medicine, New England Medical Center and Tufts University School of Medicine, Boston, Mass 02111, USA AD - New England Medical Center, Division of Clinical Decision Making, Informatics, and Telemedicine, Box 302, 750 Washington St, Boston, MA 02111. E-mail: nananda.col@es.nemc.org U2 - PMID: 9087469. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107266655&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107243617 T1 - Mammographic screening: economic evaluation of a mammography-based breast cancer screening programme in Spain. AU - Garuz R AU - Forcen T AU - Cabases J AU - Antonanzas F AU - Trinxet C AU - Rovira J AU - Anton F Y1 - 1997/03// N1 - Accession Number: 107243617. Language: English. Entry Date: 19980201. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Europe; Peer Reviewed; Public Health; UK & Ireland. Grant Information: Partially supported by grant number 92/0903 from the Fondo de Investigaciones Sanitarias (Health Research Fund) of the Spanish Ministry of Health for which we are very grateful. NLM UID: 9204966. KW - Breast Neoplasms -- Diagnosis -- In Middle Age KW - Mammography -- Economics -- Spain KW - Cost Benefit Analysis KW - Cancer Screening -- Economics -- Spain KW - Spain KW - Data Analysis, Computer Assisted KW - Sensitivity and Specificity KW - Breast Neoplasms -- Mortality KW - Descriptive Statistics KW - Data Analysis Software KW - Breast Neoplasms -- Therapy KW - Middle Age KW - Female KW - Funding Source KW - Human SP - 68 EP - 76 JO - European Journal of Public Health JF - European Journal of Public Health JA - EUR J PUBLIC HEALTH VL - 7 IS - 1 PB - Oxford University Press / USA AB - The aim of the study was to perform a cost-effectiveness analysis of a breast cancer (BC) mammography screening programme, compared to a do-nothing alternative, in Spain. Screening consisted of a biennial mammography performed on all women 50-65 years old. A marginal analysis including women 45-49 years old was also performed. With the aid of a decision tree model, the numbers of BC cases diagnosed through screening, BC cases missed by screening and false-positive BC cases were calculated. Costs were calculated by feeding local data into Markovian models and the cost-effectiveness ratio calculation was performed in a computer spread sheet. A sensitivity analysis was also conducted. Results were presented in ECUs of 1993. The cost-effectiveness ratio per avoided death is 115,500 ECUs and per saved life year 7,300 ECUs. Including women 45-49 years old in the programme raises this ratio to 229,000 and 9,400 ECUs respectively. The sensitivity analysis showed the efficacy of mammography, compliance of the programme and screening costs to be the more sensitive variables. SN - 1101-1262 AD - National Institute to Health (INSALUD), Area 3, Zaragoza, Spain UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107243617&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107324802 T1 - Physicians' opinions about decision aids for patients considering systemic adjuvant therapy for axillary-node negative breast cancer. AU - O'Connor AM AU - Llewellyn-Thomas HA AU - Sawka C AU - Pinfold SP AU - To T AU - Harrison DE Y1 - 1997/02//1997 Feb N1 - Accession Number: 107324802. Language: English. Entry Date: 19970601. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Core Nursing; Europe; Health Promotion/Education; Nursing; Peer Reviewed; UK & Ireland. NLM UID: 8406280. KW - Physician Attitudes KW - Decision Making, Patient KW - Breast Neoplasms KW - Canada KW - Cross Sectional Studies KW - Surveys KW - Mail KW - Convenience Sample KW - Chemotherapy, Adjuvant KW - Descriptive Statistics KW - Data Analysis Software KW - Chi Square Test KW - Adult KW - Middle Age KW - Aged KW - Male KW - Female KW - Human SP - 143 EP - 153 JO - Patient Education & Counseling JF - Patient Education & Counseling JA - PATIENT EDUC COUNS VL - 30 IS - 2 PB - Elsevier B.V. AB - Purpose: To examine variations in physicians' opinions about the appropriateness and content of decision aids for women with breast cancer and criteria for their evaluation. Methods: Cross-sectional survey of all 144 Ontario oncologists by Dillman's mailed survey design. The response rate was 87%. Results: The predominant current practice pattern was to spontaneously inform patients about the treatment recommendations, degree of certainty regarding the recommendations, treatment regime, benefits and side effects. Most respondents (94%) endorsed patient decision aids, particularly when there was high uncertainty about providing adjuvant treatment. Over three-quarters endorsed measuring the following outcomes of decision aids: patients' clarity of trade-offs involved (e.g. survival vs. side effects); comprehension of treatment alternatives, risks and benefits; accuracy of expectations; decision satisfaction; anxiety; commitment to the decision; length of time to complete the decision aid; and decision uncertainty. The least support was for the use of the decision itself as an outcome measure. Conclusions: There is considerable consensus regarding the indications for, content and criteria for evaluating decision aids which should be considered when developing aids relevant to the needs of clinicians and patients. SN - 0738-3991 AD - Clinical Epidemiology Unit, Ottawa Civic Hospital, C4 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada U2 - PMID: 9128616. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107324802&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107319025 T1 - CHESS: Comprehensive Health Enhancement Support System for women with breast cancer. AU - Owens BH AU - Robbins KC Y1 - 1996///1996 Fall N1 - Accession Number: 107319025. Language: English. Entry Date: 19970401. Revision Date: 20150819. Publication Type: Journal Article. Journal Subset: Core Nursing; Nursing; Peer Reviewed; USA. NLM UID: 8403490. KW - Breast Neoplasms KW - Support, Psychosocial KW - Consumer Health Information KW - Software KW - Pilot Studies KW - Female SP - 172 EP - 182 JO - Plastic Surgical Nursing JF - Plastic Surgical Nursing JA - PLAST SURG NURS VL - 16 IS - 3 CY - Baltimore, Maryland PB - Lippincott Williams & Wilkins AB - The Comprehensive Health Enhancement Support System (CHESS) was developed to assist people dealing with health crises. Needs assessments with patients were conducted in its development and validation studies performed. CHESS provides information, social support, and decision-making assistance via a personal computer and modem that are placed in patients' homes. Women of all ages and varied socioeconomic backgrounds have successfully used this program to empower them to become active participants in their care following a diagnosis of breast cancer. SN - 0741-5206 AD - University of Wisconsin, Madison, WI U2 - PMID: 9060757. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107319025&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107371155 T1 - Patient education pamphlets about prevention, detection, and treatment of breast cancer for low literacy women. AU - Glazer HR AU - Kirk LM AU - Bosler FE Y1 - 1996/03//1996 Mar N1 - Accession Number: 107371155. Language: English. Entry Date: 19960601. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Core Nursing; Europe; Health Promotion/Education; Nursing; Peer Reviewed; UK & Ireland. Grant Information: Funded by the Susan G. Komen Foundation. NLM UID: 8406280. KW - Pamphlets -- Evaluation KW - Readability KW - Patient Education KW - Breast Neoplasms -- Prevention and Control KW - Mammography KW - Poverty KW - Literacy KW - Random Sample KW - Pearson's Correlation Coefficient KW - Descriptive Statistics KW - Patient Compliance KW - Funding Source KW - Female KW - Human SP - 185 EP - 189 JO - Patient Education & Counseling JF - Patient Education & Counseling JA - PATIENT EDUC COUNS VL - 27 IS - 2 PB - Elsevier B.V. AB - The objective of this project was to identify and assess readily available patient education literature about prevention, detection and treatment of breast cancer for the patient with low literacy skills. The target population had a reading comprehension level of sixth grade or lower. Nineteen pamphlets were analyzed using RightWriter and were found to have an average readability index of 9.15, therefore requiring at least a ninth grade level of reading comprehension. As a consequence, many pieces of the available literature were inappropriate for the target population. There are implications as a broader group of health care providers becomes more involved in the treatment of low literacy patients. In providing patient education literature to poorly educated patients, special emphasis should be given to determining readability. Both currently available and newly created literature should be analyzed for readability before assuming it is an aid to patient education. SN - 0738-3991 AD - University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75235-9005 U2 - PMID: 8788348. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107371155&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107424986 T1 - Demographics and patient treatment choice in stage I breast cancer. AU - Graling PR AU - Grant JM Y1 - 1995/09//1995 Sep N1 - Accession Number: 107424986. Language: English. Entry Date: 19951101. Revision Date: 20150818. Publication Type: Journal Article; pictorial; research; tables/charts. Journal Subset: Core Nursing; Double Blind Peer Reviewed; Expert Peer Reviewed; Nursing; Peer Reviewed; USA. NLM UID: 0372403. KW - Breast Neoplasms -- Therapy KW - Demography KW - Decision Making, Patient KW - Record Review KW - Hospitals, Community KW - Registries, Disease KW - Chi Square Test KW - Factor Analysis KW - Convenience Sample KW - Orem Self-Care Model KW - Age Factors KW - Race Factors KW - Socioeconomic Factors KW - Virginia KW - Adult KW - Middle Age KW - Aged KW - Aged, 80 and Over KW - Female KW - Human SP - 376 EP - 384 JO - AORN Journal JF - AORN Journal JA - AORN J VL - 62 IS - 3 CY - Philadelphia, Pennsylvania PB - Elsevier B.V. AB - The identification of factors related to patients' treatment selections for breast cancer is important to health care providers. This study examined the relationship of selected demographics to patient treatment choice for stage I breast cancer. The study design was a retrospective chart review from a community hospital's tumor registry. The investigators used frequency distributions, chi-square tests, and factor analyses to analyze a convenience sample of 58 patients with stage I breast cancer who registered in 1992 and 1993. The results show that education level is a significant influencing factor (p = .02) in patients' treatment choices. Perioperative nurses often help patients clarify treatment option information and provide support during the decision-making process. Demographic factors may affect patients' perceptions of critical information and directly influence their treatment choices. SN - 0001-2092 AD - Fairfax Hospital, Falls Church, Va U2 - PMID: 8534056. DO - 10.1016/S0001-2092(06)63578-3 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107424986&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107345273 T1 - Commentary on Breast lump in an 85-year-old woman with dementia: a decision analysis [original article by Robinson B et al appears in J AM GERIATR SOC 1995;43(3):282-95]. AU - Wroblewski S Y1 - 1995/07//1995 Jul-Aug N1 - Accession Number: 107345273. Language: English. Entry Date: 19971101. Revision Date: 20150711. Publication Type: Journal Article; abstract; brief item; case study; commentary. Journal Subset: Nursing; Peer Reviewed; USA. NLM UID: 9301306. KW - Decision Making, Family KW - Alzheimer's Disease KW - Treatment Refusal KW - Breast Neoplasms -- Surgery KW - Aged, 80 and Over KW - Female SP - 14 EP - 14 JO - ONS Nursing Scan in Oncology JF - ONS Nursing Scan in Oncology JA - ONS NURS SCAN ONCOL VL - 4 IS - 4 CY - Philadephia, Pennsylvania PB - Nursecom Inc. AB - SYNOPSIS: A case-study approach is used to point out issues that arise in managing cancer in a person of advanced age with dementia. The patient in this case, an 85-year-old woman with Alzheimer's disease, was chairbound secondary to arthritis and deconditioning. After a caregiver discovered a breast lump, mammography was suggestive of cancer. A decision tree designed to assess risks and benefits incorporated variables imposed by the known natural history of the disease in an 85-year-old woman, perioperative risks, and anticipated benefits of surgery. The potential for local complications and the quality of extended years pose major concerns. For this patient, no clear decision was obvious and the family decided to forego surgical intervention. The authors describe the benefit in such cases of watching and waiting. SN - 1062-5720 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107345273&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107425773 T1 - Software aids breast cancer patient decisions. Y1 - 1995/02//1995 Feb N1 - Accession Number: 107425773. Language: English. Entry Date: 19951101. Revision Date: 20150711. Publication Type: Journal Article. Journal Subset: Editorial Board Reviewed; Expert Peer Reviewed; Health Promotion/Education; Peer Reviewed; USA. NLM UID: 9890954. KW - Decision Making, Patient KW - Software KW - Breast Neoplasms -- Education KW - Cancer Patients KW - Female SP - 27 EP - 29 JO - Patient Education Management JF - Patient Education Management JA - PATIENT EDUC MANAGE VL - 2 IS - 2 CY - Atlanta, Georgia PB - AHC Media LLC SN - 1087-0296 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107425773&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105851213 T1 - Surgeons try immune therapy for breast cancer. AU - Chi-Lum BI AU - Chi-Lum, B I Y1 - 1994/11/16/ N1 - Accession Number: 105851213. Language: English. Entry Date: 20080314. Revision Date: 20161112. Publication Type: journal article. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 7501160. KW - Breast Neoplasms -- Therapy KW - Decision Support Techniques KW - Gene Therapy KW - Immunization -- Methods KW - Interleukin 2 KW - Animals KW - Female KW - Interleukin 2 -- Therapeutic Use SP - 1485 EP - 1485 JO - JAMA: Journal of the American Medical Association JF - JAMA: Journal of the American Medical Association JA - JAMA VL - 272 IS - 19 CY - Chicago, Illinois PB - American Medical Association SN - 0098-7484 U2 - PMID: 7966834. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105851213&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107398048 T1 - Simulated lifetime costs of three types of employer-based, periodic, breast cancer screening programs for working-age women. AU - Griffiths RI AU - Griffiths CB AU - Powe NR Y1 - 1994/11//1994 Nov-Dec N1 - Accession Number: 107398048. Language: English. Entry Date: 19950201. Revision Date: 20150711. Publication Type: Journal Article; research; tables/charts. Journal Subset: Blind Peer Reviewed; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Health Promotion/Education; Peer Reviewed; USA. NLM UID: 8701680. KW - Occupational Health Services -- Economics KW - Cancer Screening -- Economics KW - Mammography -- Economics KW - Computers and Computerization -- Utilization KW - Cost Benefit Analysis KW - Cost Savings KW - Data Analysis, Statistical KW - Adult KW - Middle Age KW - Female KW - Human SP - 137 EP - 114 JO - American Journal of Health Promotion JF - American Journal of Health Promotion JA - AM J HEALTH PROMOT VL - 9 IS - 2 CY - Thousand Oaks, California PB - Sage Publications Inc. AB - Purpose. To estimate the lifetime cost of three types of employer-sponsored breast cancer screening programs and to identify factors influencing cost. Design. A computerized decision analysis model was constructed to compare lifetime costs of providing breast cancer screening in each of three screening programs: on-site within an employer, mobile unit visiting the employer, and off-site. Subjects. Three hypothetical cohorts of 10,000 female employees 38 years of age at time of first screening. Intervention. A cohort was enrolled in each screening program and received screening from age 38 through age 64. Employees continued to receive benefits related to breast cancer until age 100 or death. Measures. Costs in the model included those for screening, workup for a suspicious mammogram, treatment for breast cancer, short-term losses in employee productivity, and disability due to breast cancer. Approach. The model was used to estimate the mean lifetime per employee, to the employer, of the On-Site program. This cost was compared to the cost of the other programs. Results. Mean lifetime cost per employee was $5,485 for the On-Site screening program. This cost was significantly (P<.0001) lower than in the Off-Site program (by $311) or the Mobile program (by $212). The baseline results for the On-Site program were quite sensitive to the cost of screening, the sensitivity and specificity of screening, age at initiation of screening, and the underlying incidence of breast cancer in the population. Conclusion. Employers and other entities should consider these factors such as location and content in selecting the most efficient and effective breast cancer screening program. SN - 0890-1171 AD - Div Internal Med, Johns Hopkins Univ, 1830 E Monument St Rm 8061, Baltimore MD 21205 U2 - PMID: 10150714. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107398048&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107477129 T1 - Development and pilot evaluation of a computer-based support system for women with breast cancer. AU - Gustafson D AU - Wise M AU - McTavish F AU - Taylor JO AU - Wolberg W AU - Stewart J AU - Smalley RV AU - Bosworth K Y1 - 1994/03/24/ N1 - Accession Number: 107477129. Language: English. Entry Date: 19931201. Revision Date: 20150712. Publication Type: Journal Article; research; tables/charts. Journal Subset: Biomedical; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 8309337. KW - Resource Databases, Health -- Evaluation KW - Breast Neoplasms KW - Cancer Patients -- Psychosocial Factors KW - Information Needs KW - Pilot Studies KW - Convenience Sample KW - Access to Information KW - Surveys KW - Support, Psychosocial KW - Health Information KW - Decision Making, Patient KW - Quality of Health Care KW - Chemotherapy, Cancer -- Education KW - Middle Age KW - Female KW - Human SP - 69 EP - 93 JO - Journal of Psychosocial Oncology JF - Journal of Psychosocial Oncology JA - J PSYCHOSOC ONCOL VL - 11 IS - 4 PB - Taylor & Francis Ltd AB - A computer-based support system was developed to help women cope with the crisis of breast cancer. The system, called Comprehensive Health Enhancement Support system (CHESS) contains integrated information, referral, decision, and social support programs. It was developed with intensive input from potential users through needs-assessment surveys and field testing. This article reports on the results of two pilot studies involving 30 women with breast cancer. The preliminary versions of CHESS were used extensively by older and younger women and by college and high school graduates. Participants in the pilot studies suggested several content enhancements and user-friendly aids for the developing system. User surveys indicated that CHESS was easy to use and would be valuable to other women with breast cancer, their partners, and their adult children. The women reported that they experienced more positive emotions and fewer negative emotions as a result of using the system. SN - 0734-7332 AD - Univ Wisconsin, 610 Walnut St, Madison WI 54705 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107477129&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 105850801 T1 - Overestimation of test effects in clinical judgment. AU - Lyman GH AU - Balducci L Y1 - 1993///1993 Winter N1 - Accession Number: 105850801. Language: English. Entry Date: 20080314. Revision Date: 20150711. Publication Type: Journal Article; research. Journal Subset: Biomedical; Blind Peer Reviewed; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Health Promotion/Education; Peer Reviewed; USA. NLM UID: 8610343. KW - Breast Neoplasms -- Diagnosis KW - Decision Making KW - Adult KW - Aged KW - Biopsy KW - Breast Neoplasms -- Pathology KW - Breast Neoplasms -- Radiography KW - Decision Support Techniques KW - Female KW - Judgment KW - Male KW - Mammography KW - Nurses KW - Pharmacy and Pharmacology KW - Physicians KW - Predictive Value of Tests KW - Probability KW - Risk Factors KW - Sensitivity and Specificity KW - Human SP - 297 EP - 307 JO - Journal of Cancer Education JF - Journal of Cancer Education JA - J CANCER EDUC VL - 8 IS - 4 CY - , PB - Springer Science & Business Media B.V. AB - The purpose of this study was to assess the ability of health care professionals to evaluate the effect of test results on disease risk. Fifty health care professionals, including 29 physicians and 21 nonphysicians, associated with a university hospital were studied. Subjects were presented with two hypothetical scenarios involving a common clinical situation to assess the effect of test results on the estimation of disease risk. Estimates of the pretest and posttest probability of breast cancer and mammography sensitivity and specificity were elicited for hypothetical 30- and 70-year-old patients presenting with a breast lump. There was no significant difference between physician and nonphysician probability and sensitivity estimates, although physicians provided higher specificity estimates which were more consistent with literature-derived values. Both physicians and nonphysicians consistently overestimated the risk associated with a positive test result compared to probabilities derived from Bayes' theorem based on the subject's pretest probability and sensitivity and specificity estimates, as well as standard test performance estimates. There was no significant difference between posttest probability estimates for negative test results and those derived from Bayes' theorem utilizing the subject's pretest probability and sensitivity and specificity estimates. Physicians and nonphysicians both estimate test performance characteristics accurately but consistently overestimate the effect of positive test results on the probability of disease. In addition to experience with specific clinical problems, decision making by clinicians could be enhanced by training in the formal methods of decision analysis. SN - 0885-8195 AD - Department of Internal Medicine, University of South Florida College of Medicine, Tampa. U2 - PMID: 8186081. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105850801&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107451218 T1 - Commentary on Assessing the cost effectiveness of adjuvant therapies in early breast cancer using a decision analysis model [original article by Hillner B et al] and Breast cancer surveillance -- a cost effective strategy [original article by Schapira D] and Cost-effectiveness of breast cancer screening: preliminary results of a systematic review of the literature [original article by Brown M et al] [articles appear in BREAST CANCER RES TREAT 1993;25(2):97-126]. AU - Tranin AS Y1 - 1993/11//1993 Nov-Dec N1 - Accession Number: 107451218. Language: English. Entry Date: 19940901. Revision Date: 20150712. Publication Type: Journal Article; abstract; commentary. Journal Subset: Nursing; Peer Reviewed; USA. NLM UID: 9301306. KW - Breast Neoplasms -- Drug Therapy KW - Breast Neoplasms -- Diagnosis KW - Cancer Screening KW - Health Care Costs KW - Breast Neoplasms -- Economics KW - Decision Making KW - Chemotherapy, Adjuvant -- Economics KW - Disease Surveillance KW - Mammography KW - Risk Factors KW - Time Factors KW - Cost Benefit Analysis KW - Female SP - 21 EP - 21 JO - ONS Nursing Scan in Oncology JF - ONS Nursing Scan in Oncology JA - ONS NURS SCAN ONCOL VL - 2 IS - 6 CY - Philadephia, Pennsylvania PB - Nursecom Inc. AB - SYNOPSIS: The cost of healthcare is an issue for anyone who interfaces with the healthcare system. These three articles were originally presented in a mini-symposium called 'Cost analysis of diagnosis and treatment in breast cancer.' The first article describes a decision-analysis model to assess the potential clinical and financial effects of using adjuvant therapies. The second reviews current surveillance practices following the initial diagnosis and treatment of breast cancer; the author argues that there are no data to support the standard intensive surveillance practices and suggests a more minimal approach. The third article explores the cost-effectiveness of breast cancer screening with mammography, with emphasis on reimbursement and coverage issues affecting medical oncologists. SN - 1062-5720 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107451218&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107469861 T1 - A nursing intervention strategy to foster patient involvement in treatment decisions. AU - Neufeld KR AU - Degner LF AU - Dick JAM Y1 - 1993/05//1993 May N1 - Accession Number: 107469861. Language: English. Entry Date: 19930801. Revision Date: 20150712. Publication Type: Journal Article; tables/charts. Journal Subset: Core Nursing; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Nursing; Peer Reviewed; USA. NLM UID: 7809033. KW - Decision Making, Patient KW - Oncologic Nursing KW - Nursing Interventions KW - Breast Neoplasms KW - Genital Neoplasms, Female KW - Female SP - 631 EP - 635 JO - Oncology Nursing Forum JF - Oncology Nursing Forum JA - ONCOL NURS FORUM VL - 20 IS - 4 CY - Pittsburgh, Pennsylvania PB - Oncology Nursing Society AB - This article describes an intervention strategy designed to provide decisional support for patients with cancer who want to participate in medical-treatment decisions. This strategy is based on the concepts of commitment and control and on a simple technique for determining the degree of involvement the patient desires. It has been tested on women with a confirmed diagnosis of breast or gynecologic cancer and on women referred for a second opinion and diagnostic workup for suspicious lesions. The emphasis is on the patient's agenda, including assessing to what extent she wants to participate, helping her to identify questions, and supporting her in obtaining the information she wants and needs. The strategy has been incorporated successfully into a busy oncology clinic schedule. The next challenge is to conduct research to evaluate the effect of providing decisional support on quality of life. SN - 0190-535X AD - St Boniface General Hosp, Winnipeg, Manitoba, Canada U2 - PMID: 8321704. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107469861&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107462940 T1 - Deciding on breast cancer treatment: a description of decision behavior. AU - Pierce PF Y1 - 1993/01//1993 Jan-Feb N1 - Accession Number: 107462940. Language: English. Entry Date: 19930401. Revision Date: 20150712. Publication Type: Journal Article; research. Journal Subset: Core Nursing; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Nursing; Peer Reviewed; USA. NLM UID: 0376404. KW - Breast Neoplasms -- Therapy KW - Decision Making, Patient KW - Women KW - Cancer Patients KW - Convenience Sample KW - Interviews KW - Qualitative Studies KW - Grounded Theory KW - Constant Comparative Method KW - Adult KW - Middle Age KW - Aged KW - Aged, 80 and Over KW - Female KW - Human SP - 22 EP - 28 JO - Nursing Research JF - Nursing Research JA - NURS RES VL - 42 IS - 1 CY - Baltimore, Maryland PB - Lippincott Williams & Wilkins AB - The purposes of this study were to describe the unaided decision-making process of women facing treatment for early stage breast cancer and to provide the empirical grounding to develop a conceptual framework for more structured research. A convenience sample of 48 women completed an open-ended interview while they were making a decision. A qualitative analysis of these interviews identified five empirical indicators of decision behavior: (a) perceived salience of alternatives, (b) decision conflict, (c) information seeking, (d) risk awareness, and (e) deliberation. The configurations of these indicators discriminated the decision maker into one of three empirically derived groups. In order of complexity, these are termed Deferrer, Delayer, and Deliberator. SN - 0029-6562 AD - School Nurs, Univ Michigan, Ann Arbor, MI U2 - PMID: 8424063. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107462940&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107415796 T1 - Commentary on A bedside decision instrument to elicit a patient's preference concerning adjuvant chemotherapy for breast cancer [original article by Levine M et al appears in ANN INTERN MED 1992;117(1):53-8]. AU - Maienza JP Y1 - 1992/11//1992 Nov-Dec N1 - Accession Number: 107415796. Language: English. Entry Date: 19950801. Revision Date: 20150711. Publication Type: Journal Article; abstract; brief item; commentary. Journal Subset: Nursing; Peer Reviewed; USA. NLM UID: 9301306. KW - Breast Neoplasms -- Drug Therapy KW - Antineoplastic Agents, Combined -- Therapeutic Use KW - Neoplasm Metastasis KW - Antineoplastic Agents, Combined -- Adverse Effects KW - Breast Neoplasms -- Mortality KW - Age Factors KW - Antineoplastic Agents, Combined -- Administration and Dosage KW - Analysis of Variance KW - Regression KW - Outcomes (Health Care) KW - Middle Age KW - Aged KW - Aged, 80 and Over KW - Female SP - 16 EP - 16 JO - ONS Nursing Scan in Oncology JF - ONS Nursing Scan in Oncology JA - ONS NURS SCAN ONCOL VL - 1 IS - 4 CY - Philadephia, Pennsylvania PB - Nursecom Inc. AB - SYNOPSIS: The authors report on an instrument to educate women with early-stage breast cancer about choices in chemotherapy treatment. The instrument consists of a visual aid (decision board) with written material that includes information on chemotherapy, probability of cancer recurrence, meaning, and quality of life associated with treatment choice and outcomes. Content validity and test-retest reliability (k = .86) were evaluated in 30 healthy female volunteers. The tool has been used with 37 newly diagnosed women with node-negative breast cancer. Patients reported that the instrument was helpful in decision making and in identifying their treatment preferences. [Original article NLM unique identifier: 92281275 (research)] SN - 1062-5720 UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107415796&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107512958 T1 - Factors women take into account when deciding upon type of surgery for breast cancer. AU - Ward S AU - Heidrich S AU - Wolberg W Y1 - 1989/12//1989 Dec N1 - Accession Number: 107512958. Language: English. Entry Date: 19900301. Revision Date: 20150712. Publication Type: Journal Article; research; tables/charts. Journal Subset: Core Nursing; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Nursing; Peer Reviewed; USA. NLM UID: 7805358. KW - Decision Making KW - Breast Neoplasms -- Surgery KW - Mastectomy -- Methods KW - Radiotherapy KW - Body Image KW - Combined Modality Therapy KW - Descriptive Research KW - Interviews KW - Case Control Studies KW - Information Resources KW - Professional-Patient Relations KW - Attitude to Health KW - Adult KW - Middle Age KW - Aged KW - Female KW - Human SP - 344 EP - 351 JO - Cancer Nursing JF - Cancer Nursing JA - CANCER NURS VL - 12 IS - 6 CY - Baltimore, Maryland PB - Lippincott Williams & Wilkins AB - For women with stage I or II breast cancer, radomized trials have demonstrated no significant difference in survival rates between women receiving modified radical mastectomy (MRM) and women receiving breast conserving (BC) surgery. Therefore, many women are now in a position of having a choice between these two options. Twenty-two women who met the surgical criteria for having this choice were interviewed 1 to 2 weeks postsurgery to determine factors they had considered when deciding between MRM and BC, how much they wished to participate in decision-making, and the sources of information they used. The sample was purposefully limited to women attending one clinic in order to insure control over variables such as the information to which patients are exposed. When asked why they had chosen a given surgery, two factors, concerns about radiotherapy (p = 0.003) and body integrity (p = 0.04), emerged as significantly different for women choosing BC vs. MRM. Furthermore, women reported that participation in decision-making was important to them and that they had had sufficient participation in the decision-making process. Finally, they rated 'people' sources of information as more important than written or visual materials, suggesting that nurses and other care providers are important in supporting women through the decision-making process. SN - 0162-220X U2 - PMID: 2590902. UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107512958&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER - TY - JOUR ID - 107627418 T1 - Questions about breast self-examination... patient education aid. Y1 - 1982/03/15/1982 Mar 15 N1 - Accession Number: 107627418. Language: English. Entry Date: 19821201. Revision Date: 20150712. Publication Type: Journal Article; pictorial. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 0246161. KW - Patient Education KW - Breast Neoplasms -- Diagnosis KW - Breast Self-Examination SP - 57 EP - 58 JO - Patient Care JF - Patient Care JA - PATIENT CARE VL - 16 CY - North Olmsted, Ohio PB - Advanstar Communications Inc. SN - 0031-305X UR - http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107627418&site=ehost-live&scope=site DP - EBSCOhost DB - ccm ER -