Prostate cancer screening (PCS) remains controversial in its efficacy, making shared decision-making (SDM) essential to ensure informed choices. However, racial and ethnic minority men in the United States experience persistent disparities in PCS participation and outcomes. Despite these disparities, how SDM interventions have been designed, implemented, and evaluated for these populations remains unclear. To address this gap, this systematic review examined SDM interventions for PCS among minority men, with a specific focus on the extent to which interventions incorporated key SDM features (information exchange, deliberation, and decision implementation). Six databases (PubMed, Embase, CINAHL, PsycINFO, Web of Science, and Scopus) were used to search for U.S.-based, English-language studies published in the past ten years. We included studies that evaluated SDM interventions for PCS among racial and ethnic minority men. Eighteen studies met the inclusion criteria. Most targeted African American men, with limited racial/ethnic diversity. The majority of interventions were delivered as single-session programs. While all studies supported information exchange, few incorporated the full spectrum of SDM components. Outcome measures were inconsistent across studies, and critical variables relevant to minority populations, such as trust in healthcare, were not assessed. These findings illustrate ongoing challenges in both the design and evaluation of SDM interventions, including limited application of core SDM features and lack of population diversity. This review calls for future studies to develop and test culturally adapted, multi-component SDM interventions. Such efforts are needed to advance SDM research and ultimately contribute to more equitable, patient-centered cancer care.

OBJECTIVE:Despite racial/ethnic disparities in prostate cancer (PCa) outcomes, evidence on screening-specific outcomes across diverse populations remains limited. This study examined racial/ethnic differences in PCa screening, tumor characteristics, and mortality, among White, Black, Hispanic, and Asian men Methods: Secondary analysis of the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (1993-2022) in the United States (N = 73,158). Chi-square tests compared screening outcomes, tumor characteristics, and mortality across racial/ethnic groups. Adjusted rate ratios (aRRs) were estimated for incidence through 2017, and mortality through 2022, and survival was assessed using Kaplan-Meier and Cox models. RESULTS:Screening outcomes differed by race and ethnicity. Black men had elevated false-positive prostate-specific antigen rates, biopsy rates, and prostate cancer-specific mortality (aRR = 1.97, 95% CI = 1.53, 2.53 vs. White). Asian men had the highest rate of high-grade tumors (p < 0.01) despite the lowest mortality. However, these mortality differences for Black and Asian men relative to White men were not observed in 2013-2022. Hispanic men had false-positive patterns similar to White men but lower biopsy conversion. CONCLUSIONS:PCa screening disparities reflected distinct risk profiles and tumor biology across groups. While mortality gaps attenuated over time, persistent differences underscore the need for population-specific screening strategies and research.

With the growing population of individuals living with and beyond cancer-who often have a variety of complex health needs across their lifetimes-coordinated multidisciplinary, multispecialty expert care is needed to ensure comprehensive survivorship cancer care beginning at diagnosis. Guided by the July 2023 US National Academies of Sciences, Engineering, and Medicine workshop, we describe the evidence and propose steps to (1) identify and promote clinician competencies through education and training; (2) improve communication and care coordination, including leveraging the electronic health record and digital health innovations; (3) examine health system interventions and financial strategies to facilitate multidisciplinary, multispecialty survivorship care; and (4) identify policy, payment, and advocacy challenges and opportunities to achieve equitable, accessible, high-quality care. Although the recommendations are centered on the United States, their applicability to other countries should also be explored.

Ostomy-related odor is a common, distressing symptom, yet its association with body image disturbance (BID) in colorectal cancer (CRC) survivors remains understudied. We examined whether perceived ostomy odor was associated with BID and whether this association varied by ostomy status (temporary vs. permanent) and sex. In a cross-sectional online survey of 130 CRC survivors with ostomies (Stages I–III), perceived ostomy odor was assessed with a single item and BID with the Body Image Scale. We used hierarchical multiple regression controlling for age, sex, BMI, cancer stage, time since ostomy surgery, and ostomy status, followed by interaction and stratified analyses. Higher perceived ostomy odor was associated with greater BID (Model 2: B = 0.89, p = 0.006; ΔR2 = .044). The odor × ostomy status interaction was significant (B = − 1.39, p = 0.031): odor was associated with BID among participants with a temporary ostomy (B = 1.98, p < 0.001) but not among those with a permanent ostomy (B = 0.21, p = 0.595). The odor × sex interaction was also significant (B = − 1.44, p = 0.045): odor was associated with BID among women (B = 1.81, p = 0.003) but not men (B = 0.54, p = 0.133). Perceived ostomy odor was associated with greater BID, with stronger associations among participants with temporary ostomies and among women. Odor management may be a clinically relevant target for reducing BID in higher risk subgroups.

BACKGROUND:Shared decision-making (SDM) has emerged as a gold standard in cancer care, with the growing development of interventions to support it. However, SDM remains suboptimal due to inconsistent definitions and measurements with various implementation challenges. OBJECTIVE:This scoping review aims to map the literature on SDM in cancer care within the United States, focusing on how it is defined, implemented, measured, and evaluated. METHODS:Arksey and O'Malley's methodology was used. We included research conducted in the United States involving patients with cancer in SDM. PubMed, CINAHL, Web of Science, and Embase were searched in December 2023, with an updated search conducted in May 2025, for studies published in English between 2018 and 2024. RESULTS:From the initial 1259 articles, 20 studies were included, revealing inconsistency in how SDM was defined and operationalized. In particular, family caregivers were inconsistently recognized as stakeholders. Although most studies reported using tools to support SDM, these varied in format and clinical context, while measurement approaches differed across studies, with a lack of standardization limiting comparability. Research was also disproportionately concentrated on specific types of cancer and academic settings. CONCLUSION:This review highlights persistent gaps in the concept, from inconsistent definitions to varied measurement practices, and limited scope across settings. Findings indicate the need for advanced nursing research to standardize SDM definitions and broaden its implementation. IMPLICATIONS FOR ONCOLOGY NURSING PRACTICE:SDM in oncology remains challenging. Addressing identified gaps is important to advancing equitable, comprehensive, and patient-centered cancer care decision-making.

OBJECTIVES: To assess racial and ethnic differences in prostate-specific antigen (PSA) screening and shared decision-making(SDM) and examine whether SDM modifies screening rates by race and ethnicity. SAMPLE & SETTING: Data from the 2021-2023 Behavioral Risk Factor Surveillance System were analyzed, including 10,778 men aged 55-69 years eligible for PSA screening. METHODS & VARIABLES: Descriptive statistics and chi-square tests assessed racial and ethnic differences in PSA screening and estimated SDM (eSDM) use. Multiple logistic regression models evaluated the impact of eSDM on PSA screening rates, including an interaction term for race and ethnicity and eSDM. RESULTS: Amongthe sample, 46% reported undergoing PSA screening in the past year. eSDM was a significant predictor of PSA screening. After adjusting for eSDM and covariates, racial disparities in screening rates were no longer significant. Only Asian American men showed a significantly lower likelihood of screening followingSDM exposure compared to White men. IMPLICATION FOR NURSING: SDM can reduce racial and ethnic disparities in PSA screening. In addition, factors like healthcare access significantly influence screening rates, requiringtargeted investigation. The results call forfurther investigation to culturally optimize SDM.

PROBLEM IDENTIFICATION:The use of a decision aid (DA) for women facing the decision of contralateral prophylactic mastectomy (CPM) is limited. This article aimed to examine the literature for studies testing a DA for patients diagnosed with unilateral breast cancer considering CPM. LITERATURE SEARCH:A comprehensive search was conducted in CINAHL®, Ovid MEDLINE®, PubMed®, Web of Science, PsycINFO®, and Cochrane Library databases from 2017 to 2024. DATA EVALUATION:The studies were assessed for relevance in testing a patient DA for CPM in patients diagnosed with unilateral breast cancer. Studies were evaluated using the Mixed Methods Appraisal Tool, version 2018. SYNTHESIS:Five studies met inclusion criteria. These studies included one pre-/postassessment cohort pilot study, one randomized controlled trial, two mixed-methods studies, and one qualitative study. Studies included 370 patients and 50 clinicians in the breast oncology setting. IMPLICATIONS FOR PRACTICE:Oncology nurses can play a key role in advocating for shared decision-making for patients considering CPM. Additional testing of a DA for patients diagnosed with unilateral breast cancer considering CPM should be considered.

PURPOSE:The aim is to examine the relationships between ostomy leakage, odor, peristomal skin complications (PSC), and anxiety symptoms in colorectal cancer (CRC) survivors with ostomies. DESIGN:Cross-sectional design. METHODS:One hundred thirty CRC survivors with ostomies (Stages I-III) were recruited from online support groups. Participants completed assessments of ostomy-related issues using single-item Likert scales measuring leakage, odor, and PSC. Anxiety symptoms were measured using the Generalized Anxiety Disorder-7. Baron and Kenny's mediation model, with a series of regression analyses, examined relationships between variables while controlling for demographic and clinical factors. RESULTS:Ostomy leakage significantly predicted odor intensity (β = 0.61, P < .001), PSC (β = 0.51, P < .001), and anxiety (β = 0.23, P = .003). In mediation analysis, odor demonstrated a significant association with anxiety (β = 0.19, P = 0.039), while leakage's direct effect became nonsignificant (β = 0.11, P = 0.249). Peristomal skin complications showed no significant association with anxiety (β = -0.05, P = 0.575). Race and treatment status maintained significant associations with anxiety across all models. CONCLUSIONS:Ostomy odor mediates the relationship between leakage and anxiety among CRC survivors with ostomies, suggesting that odor management may be crucial for reducing anxiety in this population.

BACKGROUND:Bladder cancer disproportionately affects older adults, making addressing age-specific unmet needs essential. Understanding how sociodemographic, clinical, and personal/social resource factors influence unmet needs can help clinicians deliver tailored interventions to improve outcomes. OBJECTIVES:(1) Examine differences in unmet needs for patients aged <65 and ≥65, and (2) determine sociodemographic, clinical, and personal/social resource factors associated with unmet needs for patients aged <65 and ≥65. METHODS:We conducted a cross-sectional study of survey data for adults aged 18 to 85 from the Bladder Cancer Advocacy Network. Unmet needs were identified a priori (psychological, health system and information, physical/daily living, patient care/support, sexuality, logistics, communication with a spouse/partner, and communication with clinicians) and assessed using the Bladder Cancer Needs Assessment Scale-32. Univariate analyses and backward model selection were used to identify sociodemographic, clinical, and personal/social resource variables associated with unmet needs for patients <65 and ≥65. RESULTS:Overall, 155 patients with bladder cancer were included. Patients <65 had more psychological, patient care and support, sexuality, and communication with spouse/partner unmet needs, while patients ≥65 had more health system and information unmet needs. Multivariable analyses revealed significant differences in associations between unmet needs and social support, self-efficacy, and maladaptive coping for each distinct age group. Differences in unmet needs by patient sex emerged, with women experiencing more unmet needs than men in the older group. CONCLUSION:Findings underscore the need for tailored supportive care strategies accounting for how age, patient sex, and personal/social resources may impact unmet needs to improve bladder cancer care and outcomes.

PURPOSE:Mutuality between cancer patients and family caregivers affects treatment outcomes. Despite increasing recognition of the interdependent relationship between patients and family caregivers, a clear definition of mutuality in dyads is still lacking. This lack of definition challenges developing measurement tools, advancing research, and effectively applying the concept in practice. This concept analysis aims to examine the concept of mutuality between patients and family caregivers' dyads in cancer care. METHODS:Walker and Avant's approach was used to define attributes, antecedents, consequences, and empirical referents of mutuality in cancer patient-family caregivers. Literature was searched from PubMed, Web of Science, CINAHL, and Embase. RESULTS:While the definition of mutuality varies, it is characterized by interconnection, reciprocity, shared understanding, and adaptability. It originates from antecedents such as cancer diagnosis, existing bonds, effective communication, and supportive environments, leading to improved psychological health, enhanced relationship quality, and better coping strategies. CONCLUSION:This study revealed the unique characteristics of mutuality related to cancer trajectory. This underscores the development of standardized tools and the need for cancer-type-specific research to enhance patient and caregiver well-being. Incorporating mutuality's core aspects into clinical practice can offer healthcare providers in-depth insights into cancer care, fostering improved interventions, communication, and collaborative approaches. Additionally, it advocates the need for integration of mutuality into healthcare strategies. It is needed to advance research and education, promoting improved quality of care for patient-family caregiver dyads globally.

Anxiety is one of the most common psychological issues among colorectal cancer (CRC) survivors. It can interact with physical symptoms, impacting cancer progression, survival, and quality of life. This scoping review aims to explore the factors associated with anxiety in patients with CRC and the instruments used to measure anxiety. Using Arksey and O’Malley’s (2005) framework for the scoping review, studies investigating anxiety in CRC patients published in CINAHL, PubMed, PsycINFO, and Scopus between 2013 and 2024 were included. We analyzed fifty-one studies for this review. The review identified several risk factors and consequences of anxiety in CRC patients. The risk factors were classified into six domains using Niedzwiedz et al.'s (2019) framework: individual characteristics, social/ contextual factors, prior psychological factors, psychological responses to diagnosis and treatment, characteristics of cancer, and treatment. The consequences of anxiety were classified into three categories: global health status/quality of life, functions, and symptoms/problems. The most frequently used tool was the Hospital Anxiety and Depression Scale, with International Classification of Diseases codes being the second most used. This scoping review highlighted the intricate interaction between biological and psychosocial aspects in the lives of CRC survivors. It also identified unique factors associated with anxiety among these individuals. However, the review found some inconsistencies in the results related to anxiety-related factors, potentially due to differences in study populations, designs, measurement tools, and analysis methods. Implications for Cancer Survivors. This review underscores the potential for interventions targeting modifiable factors to prevent or reduce anxiety and enhance the quality of life for CRC survivors.

Innovative ways of screening for cognitive decline are urgently needed to increase detection and access to early treatment, particularly for those at highest risk for morbidity and mortality. The aim of this scoping review was to identify how cognitive screening is conducted within primary care and other clinical settings, specifically focusing on the use of lay navigators. Using Arksey and O’Malley’s framework for scoping reviews, inclusive of collaborators’ feedback, we included English-language research articles published after 2010 and identified ten articles. We found that lay navigators could effectively screen for common memory problems, provide support to patients and caregivers’ needs, and deliver standardized education. Incorporating cognitive screening by lay navigators can facilitate earlier access to effective treatment, especially by those burdened by existing disparities. Future research and widespread adoption of these innovative methods may improve earlier screening and thus early detection and treatment in primary care settings.

Survival rates for people with cancer and quality of life for survivors have increased significantly as a result of innovations in cancer treat-ment, improvements in early detection, and improved healthcare access. In the United States, 1 in 2 men and 1 in 3 women will be diag-nosed with cancer in their lifetime. As more cancer survivors and pa-tients remain in the workforce, employers must evaluate how they can adjust workplace policies to meet employee and business needs. Unfor-tunately, many people still encounter barriers to remaining in the work-place following a cancer diagnosis for themselves or a loved one. In an effort to explore the impacts of contemporary employment policies on patients with cancer, cancer survivors, and caregivers, NCCN hosted the Policy Summit "Cancer Care in the Workplace: Building a 21st Cen-tury Workplace for Cancer Patients, Survivors, and Caretakers" on June 17, 2022. This hybrid event, through keynotes and multistakeholder panel discussions, explored issues regarding employer benefit design, policy solutions, current best and promising practices for return to work, and how these issues impact treatment, survivorship, and caregiv-ing in the cancer community.

A qualitative descriptive approach examined African American nurse scientists' (AANSs') experiences with African American research participants despite obstacles of structural racism. Fourteen nurse scientists participated in semistructured interviews that provided data for the thematic analysis. Major themes included barriers to overcome as doctoral students, cultural experiences with structural racism, designers of culturally sensitive research, and humanitarian respect and relationship depth. This is the first research study to illuminate the contributions of AANSs who lead research in health disparities. Therefore, nursing leadership needs to illuminate AANSs' contributions, increase nurse diversification, and dismantle structural racism that creates obstacles that ultimately impact population health.

PURPOSE:To determine the feasibility and acceptability of using a patient decision aid (DA) for women with elevated breast cancer risk who are considering MRI screening.METHODS:This pilot study employed a mixed methods design to develop, modify, and test an interactive DA. The DA was administered among a consecutive patient sample with an estimated Tyrer-Cuzick v.8 lifetime breast cancer risk of 20% or greater and without a pathologic genetic mutation. The decisional conflict scale was used to measure decisional conflict. Post-intervention provider and patient feedback evaluated shared decision-making, feasibility, and acceptability.RESULTS:Twenty-four patients participated, with a median age of 44 years. Prior to DA use, sixteen patients (67%) were unsure whether to add MRI to their screening, six patients elected MRI (25%), and two patients declined MRI (8%). Following DA use, thirteen of sixteen of the initially undecided participants (81%) established a preference, with eleven electing to add MRI screening. Of participants with an initial preference, all maintained the same decision following use of the DA. Prior to the DA, the median decisional conflict score among participants was 25% (range 0-60%) compared with 0% (range 0-25%) after the DA. Healthcare providers reported that the DA was useful and easily incorporated into clinical workflow.CONCLUSIONS:This pilot study shows that there may be a benefit to DA utilization in the high-risk breast cancer clinic to guide shared decision-making in establishing a screening preference. The findings warrant further research to test the use of the DA in a larger, multi-site trial.

A qualitative descriptive approach examined perspectives of African Americans (AA) on their participation in health research despite historical research mistreatment. Nineteen AAs participated in semistructured interviews that provided data that were analyzed using thematic analysis. Salient themes included race concordance, being respected and valued by the researcher, research participation motivators, and cultural experiences of racism in health care. This study challenges dominant ideology that AAs are unwilling to participate in research and offers solutions to promote research inclusive of their perceptions. Therefore, researchers need to design research with inclusiveness and transparency that openly displays how research will impact future generations.

Purpose Shared decision making (SDM) among the oncology population is highly important due to complex screening and treatment decisions. SDM among patients with cancer, caregivers, and clinicians has gained more attention and importance, yet few articles have systematically examined SDM, specifically in the adult oncology population. This review aims to explore SDM within the oncology literature and help identify major gaps and concerns, with the goal to provide guidance in the development of clear SDM definitions and interventions. Methods We conducted a scoping review using the Arksey and O’Malley approach along with the PRISMA Extension for Scoping Reviews Checklist. A systematic search was conducted in four databases that included publications since 2016. Results Of the 364 initial articles, eleven publications met the inclusion criteria. We included articles that were original research, cancer related, and focused on shared decision making. Most studies were limited in defining SDM and operationalizing a model of SDM. There were several concerns revealed related to SDM: (1) racial inequality, (2) quality and preference of the patient, caregiver, and clinician communication is important, and (3) the use of a decision-making aid or tool provides value to the patient experience. Conclusion Inconsistencies regarding the meaning and operationalization of SDM and inequality of the SDM process among patients from different racial/ethnic backgrounds impact the health and quality of care patients receive. Future studies should clearly and consistently define the meaning of SDM and develop decision aids that incorporate bidirectional, interactive communication between patients, caregivers, and clinicians that account for the diversity of racial, ethnic, and sociocultural backgrounds and preferences.