Understanding Barriers to Providing Psychosocial Interventions in the Primary Care Setting for Young Women with Breast Cancer

Abstract

Background: Young women with breast cancer encounter some unique psychosocial stressors that develop at diagnosis and persist into survivorship. These stressors include grief and concern relating to treatment options; treatment side effects; complications with reproductive health; body image disturbances; inadequate role fulfillment as mother and intimate partner; and financial strains (Johnson-Turbes et al., 2015). These stressors can interfere with disease management by heightening anxiety, depression, and physical consequences of the diagnosis; therefore, it is critical to implement psychosocial interventions in the patient’s care plan (Christophe et al., 2015). Managing emotional distress may assist the patient with understanding her diagnosis; retaining education; enhancing decision-making skills; controlling symptoms related to her disease and treatment; and maintaining a functioning role in daily life (Drageset, Lindstrom, Giske, & Underlid, 2012). Purpose: The purpose of this needs assessment is to gain insight into Nevada health care providers’ (physicians, APNs, physician-assistants, and nurses) knowledge of psychosocial needs of young women with breast cancer, the providers’ level of comfort for implementing psychosocial care to these patients, and barriers to offering psychosocial interventions at the time of diagnosis in the primary care setting to young women with breast cancer in Southern Nevada. Design: A quantitative descriptive needs assessment in the form of a self-report survey that consisted of Likert scale and multiple-choice questions using the web-based software Qualtrics administered via email to participants who met inclusion criteria. Setting: Om Medical Clinic in Las Vegas, Nevada. Limitations: Some participants chose not to answer all questions in the survey. Incomplete surveys may increase bias due to inconsistent data responses for the variables (Polit & Beck, 2012). Also, the project requested participants to self-assess their knowledge and comfort level regarding psychosocial care for young women with breast cancer; yet, no attempt was made to evaluate their actual knowledge or ability to provide care to the particular patient population. Results: Fifteen providers (83%) agreed to participate in the project and completed the survey. The majority of providers reported having a lack of knowledge and comfort level in most of the common psychosocial needs experienced by young women with breast cancer. Reportedly, over half of respondents needed more education and training in the areas of loss of fertility, dating or relationship concerns, and decreased or impaired sexual functioning. Aside from a lack of knowledge regarding issues faced by young women with breast cancer, insufficient time to provide counseling was another barrier frequently reported by the primary care providers. Conclusions: Young women with breast cancer often endure psychosocial distress after initial diagnosis and long after treatment because of specific age-related stressors (Ruddy et al., 2013). Health care providers must pay close attention to the needs of these young women that target areas of disease and treatment education, body image, fertility, social support, and survivorship to improve their quality of life through enhanced coping and disease self-management (Ruddy et al., 2013).