title: Problems in transition and quality of care: perspectives of breast cancer survivors.
abstract: OBJECTIVE
  We conducted a qualitative study to explore breast cancer survivors' perceptions and attitudes about their current healthcare utilization, screening, and information needs.
  
  
  METHODS
  We completed eight focus groups of breast cancer survivors. We included women, adult survivors, with an initial diagnosis of breast cancer in the year 2000, treated, and without a recurrence as per medical record. To analyze transcripts, we used grounded theory methods, wherein unexpected themes and direct answers emerged from consensus between co-coders.
  
  
  RESULTS
  Focus groups included 33 participants, the majority of whom were white (84.8%), college-educated (66.7%), and covered by private medical insurance (75.7%) or Medicare (27.3%). Participants' perceptions and attitudes about care were framed in terms of personal experiences (including facing barriers to screening, feeling in limbo in the healthcare system, having problems with communication with and between physicians, confusion about symptoms, and using self-prescribe remedies), personal attitudes (including strong opinions about what survivorship means, concerns about recurrence, and changes in self-perception and agency), and social influences (including modeling others' behaviors, changes in social life, and listening to family).
  
  
  CONCLUSIONS
  Survivorship attitudes, recurrence fears, memories, and self-perceptions were influential personal factors in addition to self-efficacy. Solutions such as providing a cancer treatment summary might resolve many of the problems by consolidating and making readily available the numerous medical history and recommendations that survivors accrue over time, switching from provider to provider. Clinicians must also implement communication changes in their interactions with patients to enhance positive attitudes and behaviors, and leverage social influences.
authors.affiliation: The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1465, Houston, TX 77030, USA.
authors.forename: Aimee Kendall
authors.initials: AK
authors.lastname: Roundtree
authors.forename: Sharon H
authors.initials: SH
authors.lastname: Giordano
authors.forename: Andrea
authors.initials: A
authors.lastname: Price
authors.forename: Maria E
authors.initials: ME
authors.lastname: Suarez-Almazor
mesh_terms: D022126:Access to Information; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms; D005260:Female; D017144:Focus Groups; D006296:Health Services / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand; D006801:Humans; D007407:Interviews as Topic; D008403:Mass Screening; D008875:Middle Aged; D011787:Quality of Health Care; D017741:Survivors / Q000523:psychology*; D014481:United States