Download Presentation

Methodology
Buehler’s background
Corruption of GT studies
Major characteristic – Process
Interviews with open ended
questions
Further questions we should ask
Analysis began after 1st interview
Interviews will continue until no
new data
Study Topic
Rural women with breast cancer
who were unable to continue taking
an Aromatase Inhibiter (AI) because
of medication side effects.
Rural components of
community’s response
Lack of anonymity – Everyone
knows everyone and “their
business”
Concern for valued Insider
developing breast cancer
Caring for our own
Illness Trajectory
Diagnosis  biopsy  treatment
Surgery
Radiation
Chemotherapy
 Aromatase inhibitor (AI)
Aromatase Inhibitor Action
Estrogen production
“Estrogen synthesis is primarily sited peripherally in adipose
tissue, muscle and breast tissue, rather than in the ovaries
as in premenopausal women. In terms of inhibiting
production, the most specific effects are best achieved by
blocking the last step in biosynthesis, the conversion of
androgens to estrogens by the heme-containing enzyme,
aromatase.”
“This type of association provides exquisite potency for
and specificity against the aromatase enzyme” Miller, W. R.
Semin Oncol. 2003 Aug;30(4 Suppl 14):3-11.
Side Effects:
seen in literature &
our larger study purpose
Pain
Fatigue
Sleep Disturbance
Distress
Elements of Distress
Emotional
Depression
Extreme irritability (wanting to lash
out or lashing out at others – Loss of
control)
Distorted reality (“Felt like drug is
taking over”)
Extreme anxiety (“Feeling
overwhelmed”)
Elements of Distress
Cognitive
Not identified in early studies of AI’s
Additional Findings
 Minimizing, by staff as well as by patients
All subjects initially attributed side
effects from AI to other factors such as
aging, radiation, cancer
Subjects talked of information regarding
possible side effects being withheld from
them.
Patient/physician conflict regarding
medication
Additional Findings
Strategies
Disease management
Treatment management
Additional Findings
Timing
Typically an AI is started while
the pt is still receiving radiation
For patients who have difficulties,
physicians suggest a 1 week drug
holiday to see if side effects
decrease.
Additional Findings
Risk-Benefit ratio
Nursing Implications
Educate patients about possible
side effects and ways to manage
Assist patients in communicating
their experiences effectively with
their physicians to enhance
treatment efficacy. We think this
is a rich area for further study.
• Lay network
QUESTIONS