Qualitative Analysis of Interviews and Focus Groups Exploring Factors Contributing to Adherence to GnRH Agonists in Men with Prostate Cancer

Purpose Findings on the association between risk of cardiovascular disease (CVD) and the duration and type of androgen-deprivation therapy (ADT) in men with prostate cancer (PCa) are inconsistent. Methods By using data on filled drug prescriptions in Swedish national health care registers, we investigated the risk of CVD in a cohort of 41,362 men with PCa on ADT compared with an age-matched, PCa-free comparison cohort (n = 187,785) by use of multivariable Cox proportional hazards regression models. Results From 2006 to 2012, 10,656 men were on antiandrogens (AA), 26,959 were on gonadotropin-releasing hormone (GnRH) agonists, and 3,747 underwent surgical orchiectomy. CVD risk was increased in men on GnRH agonists compared with the comparison cohort (hazard ratio [HR] of incident CVD, 1.21; 95% CI, 1.18 to 1.25; and orchiectomy: HR, 1.16; 95% CI, 1.08 to 1.25). Men with PCa on AA were at decreased risk (HR of incident CVD, 0.87; 95% CI, 0.82 to 0.91). CVD risk was highest during the first 6 months of ADT in men who experienced two or more cardiovascular events before therapy, with an HR of CVD during the first 6 months of GnRH agonist therapy of 1.91 (95% CI, 1.66 to 2.20), an HR of CVD with AA of 1.60 (95% CI, 1.24 to 2.06), and an HR of CVD with orchiectomy of 1.79 (95% CI, 1.16 to 2.76) versus the comparison cohort. Conclusion Our results support that there should be a solid indication for ADT in men with PCa so that benefit outweighs potential harm; this is of particular importance among men with a recent history of CVD.

Download Full-text

Difficulties and motivations for physical exercise in women older than 65 years. A qualitative study

Revista Latino-Americana de Enfermagem ◽

10.1590/1518-8345.2392.2989 ◽

2018 ◽

Vol 26 (0) ◽

Author(s):

Yolanda López-Benavente ◽

José Arnau-Sánchez ◽

Tania Ros-Sánchez ◽

Mª Beatriz Lidón-Cerezuela ◽

Araceli Serrano-Noguera ◽

...

Keyword(s):

Cognitive Impairment ◽

Qualitative Study ◽

Physical Exercise ◽

Qualitative Analysis ◽

Focus Groups ◽

Nursing Staff ◽

Family Environment ◽

Phenomenological Theory ◽

The Other ◽

Depth Interviews

ABSTRACT Objective: to identify difficulties and motivations for the practice of physical exercise in women older than 65 years. Method: qualitative study based on the phenomenological theory, with focus groups and in-depth interviews. The nursing staff selected 15 women by intentional sampling using the following criteria: age, time dedicated to physical exercise, independence, and absence of cognitive impairment and contraindication for this activity. Two focus groups were formed (one of them did physical exercise for less than 150 minutes per week and the other at least 150 minutes per week) in addition to conducting five in-depth interviews. Qualitative analysis of the data was performed through transcription, coding, categorization, and verification of results. Results: the difficulties to start and develop physical exercise were circumscribed to the perception of poor health and lack of free time; both circumstances result from care obligation, being represented as a gender imposition. However, the motivations are related to perception of strength, need for socialization, and perception of autonomy and freedom. Conclusions: the ideological representation of gender determines the women’s decision to exercise. Knowing the meaning and significance that women give to health and their role in the socio-family environment allows nurses to develop relationships and interventions to encourage the practice of physical exercise.

Download Full-text

Mindfulness for Chronic Low Back Pain: A Qualitative Analysis

Pain Medicine ◽

10.1093/pm/pnx197 ◽

2017 ◽

Vol 19 (11) ◽

pp. 2138-2145 ◽

Cited By ~ 5

Author(s):

José G Luiggi-Hernandez ◽

Jean Woo ◽

Megan Hamm ◽

Carol M Greco ◽

Debra K Weiner ◽

...

Keyword(s):

Older Adults ◽

Low Back Pain ◽

Back Pain ◽

Qualitative Analysis ◽

Focus Groups ◽

Chronic Low Back Pain ◽

Complete Agreement ◽

Low Back ◽

Fear Of Pain ◽

Body Therapy

Abstract Objective Mindfulness is a nonpharmacologic mind-body therapy that has been shown to be effective in older adults with chronic low back pain (cLBP). There are few first-person accounts in the literature that describe the older adult experience and perspective while learning mindfulness and meditation to treat pain. The objective of this study was to investigate dominant themes present in the experiences of older adults applying mindfulness and meditation to cope with cLBP. Design Qualitative analysis of four focus groups. Subject Twenty-five adults age 65 years or older who had completed an eight-week mindfulness program. Methods The focus groups met for a comprehensive discussion session about their experience with mindfulness and meditation. The audio for each session was recorded, and the discussions were transcribed. Codebook development, qualitative coding, and thematic analysis were performed. The coders each coded all four transcripts, following which they met to adjudicate all coding differences until they were in complete agreement on coding. Results Several key themes were brought up by older adults utilizing mindfulness as a means of coping with pain, which included overcoming fear of pain (“Before [learning mindfulness], I used to dread pain”), pain awareness (“You’re focusing more on being aware than the pain; now that’s what helps me”), and pain significance (“It becomes insignificant”). Conclusions The themes identify several ways mindfulness impacts older adults with cLBP, including decreased negative emotions related to chronic pain such as fear of pain, a different perspective or change in awareness about pain, and reducing the significance of pain.

Download Full-text

Prostate Cancer Communication Strategies Recommended by Older African-American Men in South Carolina: A Qualitative Analysis

Journal of Cancer Education ◽

10.1080/08858190902876536 ◽

2009 ◽

Vol 24 (3) ◽

pp. 204-209 ◽

Cited By ~ 30

Author(s):

Daniela Friedman ◽

Sara Corwin ◽

India Rose ◽

Gregory Dominick

Keyword(s):

Prostate Cancer ◽

South Carolina ◽

African American ◽

Qualitative Analysis ◽

African American Men ◽

Communication Strategies ◽

Cancer Communication

Download Full-text

Abstract 17016: Cardiovascular Safety Profile of Gonadotropin Releasing Hormone (GnRH) Antagonist Compared to GnRH Agonist Among Patients With Prostate Cancer: A Meta-Analysis

Circulation ◽

10.1161/circ.142.suppl_3.17016 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Courtney Campbell ◽

Daniel Addison ◽

Ragavendra Baliga ◽

Ajay Vallakati

Keyword(s):

Prostate Cancer ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Gnrh Agonist ◽

Cardiovascular Events ◽

Gnrh Antagonist ◽

Gnrh Agonists ◽

Cardiovascular Safety ◽

Gnrh Antagonists ◽

Artery Disease

Introduction: Androgen deprivation therapy (ADT) is the cornerstone of advanced prostate cancer therapy. The degree that ADT contributes to cardiovascular disease remains uncertain with conflicting studies. ADT can be achieved through the use of gonadotrophin releasing (GnRH) hormone agonist or, more recently, GnRH antagonists. The objective of this study was to determine whether cardiovascular events differ after the initiation of GnRH agonist compared with GnRH antagonist in randomized control trials. Methods: From PubMed, Cochrane Central, and Embase we identified all randomized studies comparing GnRH antagonists with GnRH agonists in patients with prostate cancer from 2000-2020. Outcomes studied included major adverse cardiovascular events (MACE), coronary artery disease (CAD), cerebrovascular accidents (CVA), atrial fibrillation (AF), and heart failure (HF). A random effects model using the Mantel-Haenszel method was used to assess outcomes. Results: Overall, we identified 7 studies (n = 3298) which reported outcomes in prostate cancer patients receiving GnRH antagonists (n = 2127) compared with those receiving GnRH agonists (n = 1171). When compared to men receiving GnRH agonists, the incidence of MACE (RR 0.52, 95% CI 0.35-0.76, p<0.001) and CAD (RR 0.46, 95% CI 0.27 - 0.77, p=0.004) was lower in men receiving GnRH antagonists. There was no difference in the rates of CVA (RR 0.93, 95% CI 0.31-2.77, p=0.89), AF (RR 0.49, 95% CI 0.09-2.72, p=0.41), or HF (RR 0.55, 95% CI 0.19-1.59, p=0.52) between the two groups. Conclusion: For men with prostate cancer receiving ADT, GnRH antagonists decreased the incidence of MACE and coronary artery disease by half compared to men treated with GnRH agonists. GnRH antagonists have a more favorable cardiovascular safety profile than GnRH agonists.

Download Full-text

Implementation of ultrasound after central venous catheter insertion: A qualitative study in early adopters

The Journal of Vascular Access ◽

10.1177/11297298211053447 ◽

2021 ◽

pp. 112972982110534

Author(s):

Enyo A Ablordeppey ◽

Shannon M Keating ◽

Katherine M Brown ◽

Daniel L Theodoro ◽

Richard T Griffey ◽

...

Keyword(s):

Focus Group ◽

Central Venous Catheter ◽

Qualitative Analysis ◽

Focus Groups ◽

Venous Catheter ◽

Barriers And Facilitators ◽

Central Venous ◽

Focus Group Discussions ◽

Group Discussions ◽

Post Procedure

Background: The adoption rate of point of care ultrasound (POCUS) for the confirmation of central venous catheter (CVC) positioning and exclusion of post procedure pneumothorax is low despite advantages in workflow compared to traditional chest X-ray (CXR). To explore why, we convened focus groups to address barriers and facilitators of implementation for POCUS guided CVC confirmation and de-implementation of post-procedure CXR. Methods: We conducted focus groups with emergency medicine and critical care providers to discuss current practices in POCUS for CVC confirmation. The semi-structured focus group interview guide was informed by the Consolidated Framework for Implementation Research (CFIR). We performed qualitative content analysis of the resulting transcripts using a consensual qualitative research approach (NVivo software), aiming to identify priority categories that describe the barriers and facilitators of POCUS guided CVC confirmation. Results: The coding dictionary of barriers and facilitators consisted of 21 codes from the focus group discussions. Our qualitative analysis revealed that 12 codes emerged spontaneously (inductively) within the focus group discussions and aligned directly to CFIR constructs. Common barriers included provider influences (e.g. knowledge and beliefs about POCUS for CVC confirmation), external network (e.g. societal guidelines, ancillary staff, and consultants), and inertia (habit or reflexive processes). Common facilitators included ultrasound protocol advantage and champions. Time and provider outcomes (cognitive offload, ownership, and independence) emerged as early barriers but late facilitators. Conclusion: Our qualitative analysis demonstrates real and perceived barriers against implementation of POCUS for CVC position confirmation and pneumothorax exclusion. Our findings discovered organizational and personal constructs that will inform development of multifaceted strategies toward implementation of POCUS after CVC insertion.

Download Full-text

Abstract WP247: Paramedic Perspectives on Prehospital Stroke Care: A Qualitative Analysis

Stroke ◽

10.1161/str.47.suppl_1.wp247 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

J A Oostema ◽

Maria Tecos ◽

Deborah Sleight ◽

Brian Mavis

Keyword(s):

Qualitative Analysis ◽

Focus Groups ◽

Stroke Care ◽

Final Diagnosis ◽

Structured Interview ◽

Time Frame ◽

System Level ◽

Stroke Patients ◽

Interview Format ◽

The Right

Introduction: Ischemic stroke patients who arrive by emergency medical service (EMS) receive faster emergency department evaluations and improved rates of thrombolytic treatment. However, EMS stroke recognition and compliance with prehospital stroke quality measures are inconsistent. We hypothesized that EMS stroke care is influenced by a complex interaction of knowledge, beliefs, and system-level variables that influence behavior. Methods: Focus groups of paramedics from a single urban/suburban county were assembled to discuss their experiences identifying and transporting stroke patients. Focus groups were conducted using a semi-structured interview format and audio recorded. Transcripts of focus groups were qualitatively analyzed to identify themes, subthemes, and patterns of paramedic responses. The Clinical Practice Guidelines Framework provided the initial coding scheme, which was modified during the coding process by three coders using grounded theory methods, who came to consensus on which codes to apply. Results: Three focus groups (n=13) were conducted to reach theme saturation. Overall, paramedics reported high confidence in clinical gestalt for assessing stroke patients and a strong desire to “do the right thing,” but were unfamiliar with published guidelines. Paramedics identified variability in the clinical presentations of stroke, inadequate or inconsistent hospital guidance, and lack of feedback regarding care as principle barriers to ideal prehospital stroke care. Participants reported conflicting hospital guidance regarding the appropriate time frame for a high priority transport and hospital prenotification. Feedback regarding final diagnosis was viewed as critical for developing improved clinical acumen. Direct to CT protocols were cited as an effective way to integrate EMS into hospital stroke response. Conclusion: In this qualitative analysis, paramedics expressed a desire for clear, hospital-directed guidance and consistent feedback regarding outcomes for suspected stroke patients.

Download Full-text

Design and feasibility of integrating personalized PRO dashboards into prostate cancer care

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocv101 ◽

2015 ◽

Vol 23 (1) ◽

pp. 38-47 ◽

Cited By ~ 21

Author(s):

Andrea L Hartzler ◽

Jason P Izard ◽

Bruce L Dalkin ◽

Sean P Mikles ◽

John L Gore

Keyword(s):

Prostate Cancer ◽

Focus Groups ◽

Cancer Care ◽

Line Graphs ◽

Patient Centered ◽

Human Centered Design ◽

Patient Reported ◽

Related Quality ◽

Centered Care ◽

Health Related

Abstract Objective Patient-reported outcomes (PROs) are a valued source of health information, but prior work focuses largely on data capture without guidance on visual displays that promote effective PRO use in patient-centered care. We engaged patients, providers, and design experts in human-centered design of “PRO dashboards” that illustrate trends in health-related quality of life (HRQOL) reported by patients following prostate cancer treatment. Materials and Methods We designed and assessed the feasibility of integrating dashboards into care in 3 steps: (1) capture PRO needs of patients and providers through focus groups and interviews; (2) iteratively build and refine a prototype dashboard; and (3) pilot test dashboards with patients and their provider during follow-up care. Results Focus groups ( n = 60 patients) prioritized needs for dashboards that compared longitudinal trends in patients’ HRQOL with “men like me.” Of the candidate dashboard designs, 50 patients and 50 providers rated pictographs less helpful than bar charts, line graphs, or tables ( P < .001) and preferred bar charts and line graphs most. Given these needs and the design recommendations from our Patient Advisory Board ( n = 7) and design experts ( n = 7), we built and refined a prototype that charts patients’ HRQOL compared with age- and treatment-matched patients in personalized dashboards. Pilot testing dashboard use ( n = 12 patients) improved compliance with quality indicators for prostate cancer care ( P < .01). Conclusion PRO dashboards are a promising approach for integrating patient-generated data into prostate cancer care. Informed by human-centered design principles, this work establishes guidance on dashboard content, tailoring, and clinical use that patients and providers find meaningful.

Download Full-text

Factors contributing to non‐adherence to GnRH agonists in men with prostate cancer

International Journal of Urological Nursing ◽

10.1111/ijun.12252 ◽

2020 ◽

Vol 14 (3) ◽

pp. 134-134

Author(s):

Gincy George ◽

Sarah Rudman ◽

Louisa Fleure ◽

Hans Garmo ◽

Fidelma Cahill ◽

...

Keyword(s):

Prostate Cancer ◽

Gnrh Agonists

Download Full-text