title: Factors underlying metastatic breast cancer patients' perceptions of symptom importance: a qualitative analysis.
abstract: The symptom literature in cancer has primarily examined symptom severity, frequency and distress. Assessing cancer patients' perceptions of symptom importance-how important it is for them to see improvement in a symptom following an intervention-and factors influencing these judgments would also inform patient-centred care, but this analysis has not been undertaken. This qualitative study aimed to identify factors underlying perceptions of symptom importance among 25 symptomatic metastatic breast cancer (MBC) patients. Participants were recruited from a cancer centre in the Midwestern USA. Semi-structured interviews focused on patients' rationale for considering common symptoms (i.e., anxiety, sadness, sleep problems, pain or fatigue) to be important. Thematic analyses revealed five interrelated factors underlying MBC patients' perceptions of symptom importance: activity restriction, concentration difficulties, exacerbation of other physical symptoms, symptom-related long-term health concerns and negative impact on their relationships with others. Patients most frequently stated that a physical or psychological symptom was important because of the resulting activity restriction. Additionally, some patients considered pain to be important because it signalled potential long-term health concerns, such as worsening metastatic disease. Findings suggest that clinicians should take into account MBC patients' perceptions of symptom importance and factors underlying these judgments when making shared treatment decisions.
authors.affiliation: Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA.
authors.forename: C E
authors.initials: CE
authors.lastname: Mosher
authors.affiliation: Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA.
authors.forename: S
authors.initials: S
authors.lastname: Daily
authors.affiliation: Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA.
authors.forename: D
authors.initials: D
authors.lastname: Tometich
authors.affiliation: Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, USA.|VA HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA.|Department of Communication Studies, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA.
authors.forename: M S
authors.initials: MS
authors.lastname: Matthias
authors.affiliation: Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, USA.|Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA.|Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: S D
authors.initials: SD
authors.lastname: Outcalt
authors.affiliation: Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA.
authors.forename: A
authors.initials: A
authors.lastname: Hirsh
authors.affiliation: Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, USA.|Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Johns
authors.affiliation: Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA.
authors.forename: K
authors.initials: K
authors.lastname: Rand
authors.affiliation: Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: B
authors.initials: B
authors.lastname: Schneider
authors.affiliation: Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: L
authors.initials: L
authors.lastname: Mina
authors.affiliation: Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Storniolo
authors.affiliation: Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: E
authors.initials: E
authors.lastname: Newton
authors.affiliation: Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: K
authors.initials: K
authors.lastname: Miller
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000209:etiology; D001288:Attention / Q000502:physiology; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000523:psychology*; D004644:Emotions; D005221:Fatigue / Q000209:etiology; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008875:Middle Aged; D015146:Midwestern United States; D009362:Neoplasm Metastasis; D010146:Pain / Q000523:psychology; D010465:Perception
keywords: anxiety; fatigue; metastatic breast cancer; pain; psychological; symptoms