Congress Abstracts 2006

209

EXPLORING BREAST CANCER SUPPORT IN MANAGED CARE. Jennifer Wenzel, RN, Johns Hopkins University School of Nursing, Baltimore, MD.

Upon receiving a cancer diagnosis, patients are faced with the need to make complex treatment-related decisions that can lead to anxiety, fear and uncertainty. Managed care organizations' (MCO) emphasis on population-based approaches to illnesses along with interest in decreasing care and outcome variance and costs have created new social concerns and pressures. To date, the adequacy of cancer support services to meet patients' needs in MCOs has not been well described.

The purpose of this study was to examine patients' experiences related to cancer treatment in managed care. Sources and use of existing cancer support services were also explored.

A hermeneutic/phenomenological approach was used. This method relies on the belief that people make meaning from their lives through narrative construction.

Semi-structured interviews (n=21) with 14 MCO enrollees diagnosed with breast cancer were conducted during at least one of the following points: (1) diagnosis (2) treatment, and (3) post-treatment/follow-up. Participants had cancer requiring treatment, were > 18 years, were literate/articulate in English, and had been enrolled in their MCO > 1 year. Data analysis was accomplished through a reflexive process of transcript review, categorization and interpretation.

Women in this study perceived a lack of available support to help them successfully navigate the psychosocial and financial demands of pursuing cancer treatment in managed care. Although participants were, on the whole, highly educated and enrolled in less restrictive MCOs, they expressed difficulty, frustration and fatigue in managing the dissimilar and disconnected demands posed by the cancer and the MCO. Participants generally viewed existing support resources as incapable of meeting their specific needs during the cancer experience. Although all women discussed the need for support throughout the cancer experience, only one woman had accessed support group services during diagnosis, treatment and early follow-up in spite of the fact that most of the participants acknowledged the presence of such groups.