Congress Abstracts 2005

214

YOU JUST HAVE TO BE STRONG. Margaret Rosenzweig, PhD, CRNP-BC, AOCN^®, University of Pittsburgh, Pittsburgh, PA; and Rachael Rosenfield, RN, BSN, and Heather Alt, University of Pittsburgh School of Nursing, Pittsburgh, PA.

Mortality rates of African American (AA) women continue to exceed that of white women. There is consensus that survival equalization efforts should be focused on ensuring racially equivalent breast cancer treatment intensity.

The specific aims of the study were: (1) To identify the patient based barriers (PBB) to symptom management strategies perceived by patients with MBC and (2) To determine if PBB to symptom management strategies differs according to income and/or race.

One potential cause for healthcare disparity is such as adherence to appointments, prescriptions and advice. This explanation is best derived from the individual’s own words and experiences.

The findings from this study begin to describe the PBB to treatment and symptom management adherence according to race (White (W) or AA) and income (2003 Health and Human Services Income Guide) for women with MBC. This beginning explanatory model will help to tailor interventions so that intensive palliative chemotherapy and/or supportive care be can ensured for all women with MBC.

Qualitative research methodology based on open ended interviews of fourteen women with MBC (8 white—6 high income (HI), 2 low income (LI), 7AA—2 (HI), 5 (LI)) undergoing MBC therapy was conducted. The interviews were transcribed and analyzed for recurrent themes exploring possible patient based barriers to treatment adherence or symptom management using investigator coding and Ethnograph qualitative software (v.5).

In this preliminary analysis two overarching themes for all women and three racially differential themes served as explanatory models for PBB to treatment and symptom management adherence in MBC.

The overarching barriers to treatment and symptom management adherence were (1) questions of treatment futility for metastatic disease (2) symptom distress (pain and depression) and (3) time and expense of health related care. The racially specific barriers to treatment and symptom management for LI AA women were
1) need for minimization of symptoms (multiple roles and family optimism) and
2) stressors of poverty.

Both HIAA and LI AA women noted
1) poor understanding of illness severity.

This analysis is rich with cancer nursing implications. Interventions to increase adherence need to have particular attention to the differential burden that sociodemographic factors bring to the MBC experience.