Breast cancer (BC) and hypertension are highly prevalent among older women, and older patients without professional communication about health decisions tend to neglect self-care.1 While all hypertensive patients need to make informed decisions about adherence to screening and treatment recommendations, BC survivors must also deal with the emotional and physical after-effects of cancer, and often have trouble managing their chronic conditions.4,1 Although cancer survivors face such additional challenges, there has been little research on how BC and hypertension affect patients'attention and action for these conditions, and on how providers can assist them. This project will address that gap by studying how nurses understand and communicate with older breast cancer (BC) survivors who have hypertension. This is a growing population: there are 6.5 million cancer survivors over age 65 in the U.S., including over 800,000 BC survivors. These older BC survivors have an average of four additional chronic conditions, with hypertension by far the most common, affecting 78 percent of all women over age 65.2,3,1 As frontline providers, nurses could help improve adherence by addressing survivors'beliefs about symptoms and self-management, if they understand the patient's mental framework for self-management.1,5 In order to address these issues, we will interview nurses and hypertensive patients using as a framework Leventhal's Common Sense Model (CSM). This behavioral model has been used extensively in studying patients'illness perceptions and coping behaviors.5 We will interview participants in Assisted Living (AL), including survivors and those without a cancer history. This setting encompasses numerous older people with multiple chronic conditions, and on-site nurses who are active as observers, potentially providing advice and guiding actions by the AL residents.6 Our inquiry will include 1) how nurses arrive at perceptions and judgments about patients, whether they match the patients'perceptions, interpretations and actions, and how nurses communicate with patients about their symptoms and signs of risk 2) patients'perceptions about their conditions and judgments on adherence to specific self-care and screening guidelines for both hypertension and BC 3) whether BC survivorship interferes with appropriate behavioral responses to hypertension and cancer. Using inductive methods to analyze these data, we will develop a descriptive study of perceptions, judgments and interactions of nurses and patients. We will synthesize these results to develop instructional objectives for a future project that will train nurses to assist in patients'judgments and actions for effective self- management of their cancer and comorbid conditions.
By targeting nurses and breast cancer survivors with hypertension, which is a highly prevalent condition, this research will help provide an evidence-based foundation for a future training program that will enhance providers'awareness of survivors'needs, and help them optimize survivors'overall health behaviors.