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Purpose/Objectives: To (a) examine differences in appraisals of hereditary breast and ovarian cancer (HBOC), psychological distress, family environment, and decisional conflict between women who pursued genetic testing and their at-risk relatives who did not, and (b) examine correlations among appraisals of HBOC, psychological distress, family environment, and decisional conflict regarding genetic testing in these two cohorts of women.Design: Descriptive, cross-sectional cohort study.Setting: Two clinics affiliated with a major research university in the midwestern United States.Sample: 372 women aged 18 years and older. 200 pursued genetic testing for BRCA1 and BRCA2 mutations (probands) and 172 of their female relatives who had a greater than 10% prior probability of being a mutation carrier but had not pursued testing.Methods: After providing informed consent, probands and relatives were mailed self-administered questionnaires.Main Research Variables: Perceived risk, knowledge of HBOC risk factors and modes of gene inheritance, perceived severity, perceived controllability, psychological distress, family relationships, family communication, and decisional conflict about genetic testing.Findings: T tests revealed that probands perceived higher risk and had more psychological distress associated with breast cancer. Probands had more knowledge regarding risk factors and gene inheritance, and greater decisional conflict regarding genetic testing. Relatives reported higher perceived severity and controllability. No differences were observed in family relationships and family communication between probands and relatives. Pearson correlations revealed different patterns in knowledge, perceived controllability, family relationships, and decisional conflict between probands and relatives.Conclusions: Significant differences exist between women who pursue genetic testing and those who do not. The family environment influences adjustment to HBOC and decisions about genetic testing.Implications for Nursing: Enhancing the family communication process about HBOC can provide informational and emotional support to high-risk women and promote decision making about genetic testing. [ABSTRACT FROM AUTHOR]

Purpose/Objectives: To describe perceived breast cancer risk, identify the percentage of women with inaccurate risk perceptions, and examine the influence of perceived and objective risk on screening behavior.Design: Descriptive, correlational, cross-sectional.Setting: Community settings in a metropolitan area on the western coast of the United States.Sample: Multicultural sample of 184 English-speaking women (57% non-Caucasian, X age = 47 ± 12 years) who have never been diagnosed with cancer.Methods: Two perceived risk scales (verbal and comparative) and the Gail model were used to assess perceived and objective breast cancer risk, respectively.Main Research Variables: Perceived breast cancer risk, objective breast cancer risk, screening behavior.Findings: Participants reported that they "probably will not" get breast cancer and that their risk was "somewhat lower" than average. Family history of breast cancer was a significant predictor of perceived risk. Demographic characteristics and objective risk factors were not associated with perceived risk. Most women at high risk for breast cancer (89%) underestimated their actual risk; fewer women with low to average risk for breast cancer (9%) overestimated their risk. Age, Gail scores, and health insurance status promoted breast cancer screening; underestimation of risk had the opposite effect.Conclusions: Inaccurate perceptions of risk do not promote optimal breast cancer screening. The finding has implications for most women at high risk for developing breast cancer who underestimate their risk.Implications for Nursing: Oncology nurses can use risk assessment tools to provide individualized counseling regarding breast cancer risk factors and screening. Women at high risk who underestimate their risk could benefit from additional screening and from advances in cancer chemoprevention. [ABSTRACT FROM AUTHOR]

Purpose/Objectives: To describe knowledge of hereditary, familial, and sporadic breast cancer risk factors among women in the community and to identify characteristics associated with this knowledge. Design: Descriptive, cross-sectional. Setting: Community settings in the San Francisco Bay Area. Sample: 184 women who had never been diagnosed with cancer, were 30-85 years old (-X = 47 ± 12), and agreed to complete a questionnaire in English. Participants were from diverse racial and cultural backgrounds (i.e., 43% European descent, 27% African descent, 16% Asian descent, and 14% Hispanic descent). Many (49%) were college graduates, and 24% had a median annual family income of $30,000-$50,000. Methods: Survey. Main Research Variables: Knowledge of hereditary, familial, and sporadic breast cancer risk factors and characteristics associated with this knowledge. Findings: Although most women recognized heredity as a risk factor, some did not understand the impact of paternal family history on risk. Some women did not recognize the relationship between breast and ovarian cancer, risk factors associated with the Gail model, and that aging increases risk. Education level was the most important characteristic associated with knowledge of risk factors. Conclusions: Although age and family history are independent predictors of sporadic, hereditary, and familial breast cancer risk, women in the community could not distinguish between the three forms of the disease. Although the sample included a large number of educated women, their knowledge of breast cancer risk factors appeared incomplete. Implications for Nursing: Advanced practice nurses should provide individualized risk assessment and education regarding breast cancer risk factors. [ABSTRACT FROM AUTHOR]

Purpose/Objectives: To examine the relationship between women's reported social support and their adherence to recommended breast cancer screening guidelines. Design: Descriptive, cross-sectional survey. Setting: Community women's organizations throughout the San Francisco Bay Area. Sample: 833 mostly low-income women with a mean age of 46.2 years from three racial or ethnic groups (i.e., Latina, Caucasian, and African American) who were not breast cancer survivors. Methods: Social support was measured with a five-item, four-point, Likert scale developed for the study (Cronbach's alpha = 0.7248). Adherence to screening guidelines was measured by asking frequency of performing breast self-examination (BSE) and frequency of obtaining a clinical breast examination (CBE) and a mammogram. Research assistants and leaders of women's organizations conducted the survey in work and community settings. Main Research Variables: Social support, performance of BSE, obtaining a CBE and a mammogram, income, education, spoken language, and level of acculturation. Findings: Higher levels of social support were related to higher income and higher education. Lower levels of social support were associated with being Latina, completing the survey in Spanish, and being born abroad. Women who did not adhere to screening guidelines (for BSE or CBE) reported less social support. Conclusions: Social support is associated with adherence to breast cancer screening guidelines. Implications for Nursing: Nurses should assess women's levels of social support as a factor when evaluating adherence to breast cancer screening guidelines. [ABSTRACT FROM AUTHOR]

Purpose/Objectives: To examine family caregivers' experience of mental fatigue, identify strategies they use to manage it, and ascertain the kind of help they would like from healthcare professionals. Research Approach: Descriptive, qualitative study that was part of a larger mixed-methods study. Setting: Metropolitan comprehensive cancer center in the midwestern United States. Participants: 79 family caregivers of patients with advanced cancer who were participating in phase I clinical trials. Methodologic Approach: Caregivers completed a semistructured, open-ended questionnaire and demographic and health history forms. Findings: Caregivers were able to define mental fatigue and give many examples of it. They reported that mental fatigue did not interfere with patient care, but that it did have a negative effect on their own self-care. They identified strategies to manage mental fatigue. They wanted more information and support from professionals. Conclusions: The majority of caregivers experienced mental fatigue, which manifested as trouble concentrating, difficulty remembering things, and irritability. The majority worked outside of the home and had health problems of their own. Interpretation: Healthcare professionals need to assess caregivers for mental fatigue and find ways to help them reduce mental fatigue and restore their attention. Nurses are in a prime position to mobilize resources for caregivers to effectively manage burden and reduce mental fatigue. [ABSTRACT FROM AUTHOR]