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Biomedical subjects

M Fitch

Publications and source records attributed to M Fitch.

At least 19 recordsLinked to original sources
PubMed2001

Community cancer clinics: patients' perspectives.

In response to the challenge of providing care for cancer patients closer to home, community chemotherapy outreach programs are being developed as part of regional cancer care organizations. The purpose of this qualitative study was to gain an understanding of cancer patients' experiences of receiving chemotherapy at community chemotherapy clinics. In total, 28 patients who had received chemotherapy at 13 community-based clinics were interviewed. Qualitative analysis of the interview transcripts revealed two prevalent themes. One theme, called "balancing gains and losses," reflected how patients considered and evaluated two dimensions when making decisions about where best to undergo treatment. The dimensions considered were quality of life versus biomedical expertise. The second theme, called "communication links," reflected patients' perceptions about the continuity of their cancer care. The results of the study suggest that the impact of the delivery of services on patients and their families needs attention.

Adult↗
PubMed2001

The experience of women receiving brachytherapy for gynecologic cancer.

PURPOSE/OBJECTIVES: To explore and document the lived experience of receiving low-dose rate brachytherapy for gynecologic cancer. DESIGN: Qualitative method based on phenomenology. SETTING: Radiation treatment facility in a cancer-care setting in Toronto, Ontario, Canada. SAMPLE: Ten women between the ages of 36 and 75 (x = 59.2) receiving low-dose rate brachytherapy for cancer of the cervix or endometrium. METHODS: Verbatim data were analyzed manually using Giorgi's method of analyzing qualitative data. FINDINGS: Three themes emerged from the data: (a) women's experiences with brachytherapy were embedded within the complete context in which treatment was given, shaped by personal, environmental, and treatment-related factors, (b) the discomfort that women experienced during brachytherapy was perceived as a totality of symptoms including but not limited to pain, and (c) the brachytherapy experience was characterized by an intense focus on time and tensions embedded in issues related to time. CONCLUSIONS: When dealing with the brachytherapy treatment, women are concerned with the context in which the treatment is provided and the care that is associated with the treatment. Different and unique strategies assist women to get through treatment. Supportive nursing interventions can be implemented easily in the nursing care plan for women undergoing brachytherapy. IMPLICATIONS FOR NURSING PRACTICE: The aspects of nursing care that women perceive as positive, such as competence level of the nurse, symptom management, and providing information in sensory terms, should be strengthened. Alternatively, aspects of nursing care that are perceived negatively by women should be changed. Nurses have to avoid situations that will prolong the time of brachytherapy treatment. Nurses should support women in using coping strategies that assist them in getting through the brachytherapy treatment.

Adaptation, Psychological↗
PubMed2000

Decreased UV sensitivity, mismatch repair activity and abnormal cell cycle checkpoints in skin cancer cell lines derived from UVB-irradiated XPA-deficient mice.

Xeroderma pigmentosum group A gene (XPA)-deficient mice are defective in nucleotide excision repair (NER) and are therefore highly sensitive to ultraviolet (UV)-induced skin carcinogenesis. We established cell lines from skin cancers of UVB-irradiated XPA-deficient mice to investigate the phenotypic changes occurring during skin carcinogenesis. As anticipated, the skin cancer cell lines were devoid of NER activity but were less sensitive to killing by UV-irradiation than the XPA(-/-) fibroblast cell line. The lines were also more resistant to 6-thioguanine (6-TG) than XPA(-/-) and XPA(+/+) fibroblasts, which was suggestive of a mismatch repair (MMR) defect. Indeed, in vitro mismatch binding and MMR activity were impaired in several of these cell lines. Moreover, these cell lines displayed cell cycle checkpoint derangements following UV-irradiation and 6-TG exposure. The above findings suggest that MMR downregulation may help cells escape killing by UVB, as was seen previously for methylating agents and cisplatin, and thus that MMR deficient clones are selected for during the tumorigenic transformation of XPA(-/-) cells.

Animals↗
PubMed2000

Changing physicians' attitudes toward self-help groups: an educational intervention.

BACKGROUND: Members of self-help groups (SHGs) for support of cancer patients are concerned that physicians are skeptical about these groups and see them as potentially harmful. The purpose of this study was to assess family physicians' attitudes towards self-help groups and see whether these could be changed through an educational intervention. METHODS: A questionnaire assessing attitudes toward SHGs was mailed to 1,422 eligible Ontario family physicians, to which 911 responded (64% response rate). Responders were sent an educational package consisting of an article about self-help groups, a list of local cancer self-help groups, and a follow-up questionnaire. RESULTS: The study was completed by 584/911 family physicians (64%). After being exposed to educational material, the physicians were more positive about the helpfulness of SHGs (p = 0.021), and less concerned about SHGs' being harmful (p = 0.003). They were more positive about the potential for SHGs to provide participants with opportunities for: sharing information (p = 0.004), bonding with other patients (p < 0.001), feeling understood (p = 0.004), sharing common experiences (p = 0.004), providing hope (p < 0.001), sharing laughter (p = 0.001), becoming more assertive (p < 0.001), communicating with health professionals (p = 0.04), dealing with issues related to death and dying (p = 0.005), advocacy (p = 0.01), and overcoming isolation (p = 0.002). They were less concerned with the potential for SHGs to provide misinformation (p = 0.003), the negative effects of associating with the very ill (p = 0.002), dwelling on illness (p = 0.002), or cultivating false hope (p = 0.001). CONCLUSION: Having family physicians complete a questionnaire, followed by educational material specific to their concerns, changed their attitudes toward self-help groups. Further study is needed to see whether behavioral changes resulted.

Attitude of Health Personnel↗
PubMed2000

Perspectives on living with ovarian cancer: young women's views.

Ovarian cancer is the fourth leading cause of cancer-related deaths in women. Ovarian cancer, and its treatment, has a considerable effect on the quality of life of women diagnosed with the disease. Young women diagnosed with ovarian cancer must confront life-threatening illness at a time when many are in the midst of raising children, maintaining a household, and actively engaging in work and career activities. Very little has been reported about the perspectives of young women regarding their experiences with ovarian cancer. This article reports data from 39 women 45 years of age or less concerning the impact of ovarian cancer and its treatment as well as the availability of support. At the time of the study, the women were, on average, 38 years of age and approximately two-thirds were married and had children. About half of the women were working. The most frequently identified problems included side effects (n = 25), fear of recurrence (n = 25), and difficulty sleeping (n = 25). On average, women reported experiencing 10.4 problems since diagnosis. Of those who experienced problems, less than 50% perceived they had received adequate help. Approximately two-thirds of these women experienced a lifestyle change. Quality of life was rated significantly lower following their experience with ovarian cancer. Implications for oncology nurses emerge in areas of assessment, referral, and patient teaching.

Adaptation, Psychological↗
PubMed2000

The cancer journey: bridging art therapy and museum education.

This paper describes the application of art therapy in assisting cancer patients to visually express their cancer experience on several levels--physically, psychosocially, and spiritually. The art therapy/museum education program was developed in 1996 at the McMichael Canadian Art Collection in partnership with Toronto-Sunnybrook Regional Cancer Centre-Bayview Support Network. To date, the program has run for three rounds with 16 sessions in each round. The facilitator for all three rounds was a trained art therapist. The program provided an unique opportunity for an arts institution to serve the community at large by offering an artistic outlet in a peaceful, rural setting in contrast to a sterile hospital environment. The specific goals of the program and the general therapeutic benefits of art therapy are described. In addition, the effectiveness of an existential/phenomenological approach in not only serving the cancer population, but also bridging the two diverse disciplines--art therapy and museum education--is explored. It is suggested that an existential therapeutic approach promotes the confrontation and acceptance of death that is necessary in order to lead a more meaningful life. Moreover, a phenomenological approach promotes the act of "seeing" as an essential ingredient in gaining objectivity and bringing unconscious thoughts into consciousness. The importance of social and emotional support in the way of art therapy in addition to medical care is emphasized. Through art therapy, cancer patients are encouraged to discover ways to face pain and misfortune and be creative in their "art of living."

Adaptation, Psychological↗
PubMed2000

An innovative art therapy program for cancer patients.

Art therapy is a healing art intended to integrate physical, emotional, and spiritual care by facilitating creative ways for patients to respond to their cancer experience. A new art therapy program was designed to provide cancer patients with opportunities to learn about the McMichael Canadian Art Collection and to explore personal feelings about their cancer experience through combined gallery and studio components. The role of the facilitator was to assist in the interpretation of a participant's drawing in order to reveal meaning in the art. This paper presents patients' perspectives about the new art therapy program. Content analysis of participant feedback provided information about the structure, process, and outcomes of the program. Evaluation of the art therapy/museum education program demonstrated many benefits for cancer patients including support, psychological strength, and new insights about their cancer experience.

Adaptation, Psychological↗
PubMed1999

Complementary health practitioners' attitudes, practices and knowledge related to women's cancers.

OBJECTIVE: To document the attitudes, practices and knowledge of 3 groups of complementary practitioners (naturopathic doctors, chiropractors and massage therapists) regarding women's cancers in general and ovarian cancer specifically. DESIGN: A mailed survey questionnaire was followed by a reminder card and a second mailing of the questionnaire. SETTINGS: National samples were obtained for naturopathic doctors and chiropractors. The massage therapist sample was drawn from Ontario only because of the absence of a national listing of massage therapists. MAIN OUTCOME MEASURES: Practitioners reported response to patients' suspicious symptoms. Practitioners' perceptions of patients' motivations for seeking treatment. Practitioners' satisfaction with interactions with conventional practitioners. Practitioners' perceptions of their role in the care of women at risk of, or diagnosed with, cancer. Practitioners' perceptions of their knowledge regarding women's cancers. Practitioners' knowledge specific to ovarian cancer. RESULTS: A total of 894 completed questionnaires were returned, providing a response rate of 56%. The vast majority of practitioners who saw women with symptoms possibly related to cancer referred them to a family physician or a cancer specialist. Motivations that practitioners most frequently heard expressed by women seeking complementary treatments were "maximizing quality of life," "seeking natural approaches to healing" and "looking to stay well when disease is in remission." Most respondents were dissatisfied with patient-related communication with both family physicians and cancer specialists. The majority of complementary practitioners indicated that they have an important role to play in the postdiagnostic care of women with cancer. Considerable interest was expressed in further education concerning ovarian cancer. CONCLUSIONS: Whereas the professions reached through this survey differ in important ways from each other, they share an interest in being involved in the care of women with cancer, as well as an enthusiasm for the development of continuing professional education programs to help them better serve their clients.

Adult↗
PubMed1998

The information needs of well, longer-term survivors of breast cancer.

Nine focus groups for well, longer-term survivors of breast cancer were held in Ontario, Canada. Prevalent themes identified through analysis of focus group transcripts fell into two broad categories, one reflecting the context within which women seek information and the other reflecting the content of information desired and sought. Themes related to context included: the ongoing impact on women of their initial disease experience and continued uncertainty about possible recurrence; womens' lack of information and understanding about processes involved in developing medical knowledge; prevailing mistrust about the impact of cost curtailment policies; and, concerns related to how professional communication can aid or hinder the goal of obtaining information. Themes related to content issues included: follow-up protocols, tamoxifen, detecting signs of possible recurrence, prevention for daughters, neglected side effects of treatment, insurance, lifestyle, and unconventional therapies.

Adult↗
PubMed1998

One-on-one peer support and quality of life for breast cancer patients.

The Canadian Cancer Society's Reach to Recovery program provides one-on-one support for breast cancer patients that is delivered by breast cancer survivors. Professionally-led social support programs have generally been found to influence positively the quality of life of cancer patients. However, there is a lack of evidence on the benefits of one-on-one peer support programs. An evaluation of the Reach to Recovery program was completed in 1995 to determine if cancer patients who received the program were satisfied with the program and to determine if participation in Reach to Recovery affected the quality of life of program participants compared to patients who did not receive the program. We found that Reach to Recovery program participants were generally satisfied with the program they received and that the program has incremental benefits to the quality of life of patients with breast cancer. Peer-led, volunteer breast cancer support programs can be effective in enhancing the quality of life of breast cancer patients.

Adult↗
PubMed1998

A strategy for informing patients and health professionals about unconventional cancer therapies.

BACKGROUND: A Guide to Unconventional Cancer Therapies was produced by the Ontario Breast Cancer Information Exchange Project with the intention of meeting needs of patients, family members, and health professionals for information about unconventional therapies. Concerns raised by health professionals during the development of the guide serve as a focus for considering its impact on cancer patients who purchased it. MATERIALS AND METHODS: Purchasers of the guide were sent a survey questionnaire inquiring about their access to, use of, and attitudes toward it. RESULTS: A total of 634 individuals responded to the survey, including cancer patients, health professionals, and family members. The guide was rated moderately helpful overall, and health professionals found it significantly more helpful than did cancer patients. A minority of patients were influenced to try an unconventional therapy as a result of reading the guide. Those who did try a new therapy typically chose ones that are most popular and have few potential negative effects. CONCLUSIONS: As an informational strategy, the Guide to Unconventional Cancer Therapies has been successful. Concerns expressed by some health professionals about potential harm through implementing the strategy have been shown to be largely unwarranted, at least for study respondents.

Breast Neoplasms↗
PubMed1998

Information needs of women with metastatic breast cancer.

Eight focus groups involving women with metastatic breast cancer were held across Ontario over approximately 6 months in 1996-97. Prevalent themes identified during the sessions are reported under 2 broad dimensions: the women's expressed desire for information in specific content areas, and issues related to whether information can be either beneficial or harmful, depending on how it is provided. The women reported high needs for information, especially that which would relate to their situation. Perceived adequacy of information is closely linked to health professional engagement and care. Although the provision of information is important, the needs of these women for maintenance of hope and provision of interpersonal support and comfort are also critical.

Adult↗
PubMed1998

Self-help groups.

OBJECTIVE: To assess Ontario family physicians' attitudes toward, awareness of, and practices related to self-help groups in general and cancer self-help groups specifically. DESIGN: Mailed survey using a modified Dillman method. SETTING: Ontario family practices. PARTICIPANTS: A random sample of 1500 Ontario members of the College of Family Physicians of Canada, of whom 949 responded. A total of 911 completed questionnaires were received, for an eligible response rate of 64%. MAIN OUTCOME MEASURES: Physician demographics, practice characteristics; extent of awareness of self-help groups and their perceived value; attitudes toward self-help groups; practices related to interactions with patients about self-help groups. RESULTS: Only 40.2% of respondents were aware of six or more self-help groups in their region; 56.8% were aware of at least one cancer self-help group. Discussions with patients about groups were reported as occurring "frequently" by 12% of respondents, who indicated they made referrals to an array of groups. Ratings of group helpfulness were relatively high (83.8% scoring 3, 4, or 5 on a 5-point scale, where 5 is "very helpful"). There were low ratings of potential harm (1% scoring 4 or 5 on a 5-point scale, where 5 is "very harmful"). Confidence intervals for proportions reported on in this paper were all within 4%. CONCLUSIONS: Family physicians have predominantly positive attitudes about the potential benefits of self-help groups, and many are recommending groups to their patients.

Female↗
PubMed1997

A qualitative study of breast cancer self-help groups.

This study reports on the experience of women in four community breast cancer self-help groups in Ontario, Canada. Semi-structured interviews were conducted with 24 women, asking them about benefits and limitations of their group involvement, and about their perspectives on group processes and structures. Overall, participants reported their group involvement to be extremely helpful for navigating the short and long-term impact of breast cancer. Emotional support benefits included connecting with other breast cancer survivors, feeling understood and sharing experiences, providing hope, and sharing healing laughter. Informational and practical support benefits included sharing of important information and learning how to get what you want. Even where there were concerns about limitations or tensions of group experience, these occurred against a backdrop of appreciation and commitment. From the discussion of group processes and structures, a number of issues were identified as problematic. Most notable were how to deal with deaths of group members and how to balance the group's primary purpose of providing mutual support with secondary goals of dealing with group business and engaging in meaningful advocacy.

Adaptation, Psychological↗
PubMed1997

Towards an inclusive cervical cancer screening strategy: approaches for reaching socioeconomically disadvantaged women.

Barriers to prevention and early detection of cancer among the socioeconomically disadvantaged are important areas for public health focus. A community coalition was established in North York, Ontario, to identify a suitable primary prevention initiative, cervical screening among young women of lower economic status. Two pilot communities were selected for the project. Community members, key informants and service providers participated in a series of individual and focus group meetings to identify barriers that impede cervical screening. The benefits and challenges of such a project will be importance to practitioners eager to work collaboratively on primary prevention initiatives. This article will be of interest to nurses wanting to foster a community coalition approach to program design, planning, implementation and evaluation. It will also assist nurses with utilizing needs-based assessment in their work. Although the findings relate to a population of women in a large urban centre, the results will be useful for nurses and other health professionals planning to engage in work related to cervical screening.

Female↗