Journal Clubs are increasing in frequency as one strategy to implement evidence to inform our nursing practice. Some of you may already participate in journal clubs at your employing institutions and for some, this may be a new venture to enhance your nursing knowledge. For the purposes of this class, the on-line journal club is a graded activity. However, it is your responsibility. to complete this assignment.
based on the article, complete the table
Hi, Journal Clubs are increasing in frequency as one strategy to implement evidence to inform our nursing practice. Some of you may already participate in journal clubs at your employing institutions
PAPER Comparing provider and patient views of issues for low‐ resourced breast cancer patients Cassandra J. Enzler 1 |Shioban Torres 2 |Jennifer Jabson 3 |Arin Ahlum Hanson 4 | Deborah J. Bowen 5 1Public Health Department, UT Health Science Center at Houston, Houston, Texas 2Community Health Sciences, Boston University, Boston, Massachusetts 3Department of Public Health, University of Tennessee, Knoxville, Tennessee 4Living Beyond Breast Cancer, Program Administration, Bala Cynwyd, Pennsylvania 5Department of Bioethics and Humanities, University of Washington, Seattle, Washington Correspondence Deborah J. Bowen, Department of Bioethics and Humanities, University of Washington, 1959 NE Pacific Street A204, Seattle, WA 98195. Email: [email protected] Funding information Centers for Disease Control and Prevention, Grant/Award Number: 1 U58 DP005403 Abstract Objective:The purpose of this study was to compare provider and patient views from the same clinical settings on issues raised by low‐socioeconomic status (SES) breast cancer survivors. Methods:We conducted qualitative interviews among two groups: low‐SES breast cancer survivors (n = 37) and medical personnel (ie, physicians, nurses, and navigators; n = 8) who interact and serve with these patients from two geographically distinct low‐resourced clinical settings. These semistructured qualitative interviews used grounded theory to identify several potential themes, such as finances, resources, and medical care. Transcripts were coded and summarized into themes. Results:We analyzed each type of interview data separately then compared patient and provider perspectives. From these qualitative interviews, we discovered that low‐SES breast cancer survivors reported many unmet needs, including transpor- tation, housing, health literacy, and language, among others. Providers reported that many of these needs are served by the extensive network of supports surrounding these patients. Conclusions:These results illustrate that low‐SES breast cancer survivors have unique needs that differ from other breast cancer survivors. Many providers feel that these needs are being met, but patients have more diverse experiences. By better addressing the links between resource needs and low‐SES breast cancer survivors, quality of life can be improved. KEYWORDS comparative interviews, low‐resourced settings, patients, poverty, providers 1 | INTRODUCTION Breast cancer impacts many individuals despite continued research and development within the scientific field. 1,2 In addition to increased mortality, breast cancer negatively impacts an individual’s quality of life. 3-5 Breast cancer also has a financial impact with some individuals accruing years of medical debt even after completing treatment. 6,7 It is critical to understand the needs of breast cancer patients, so the mostpressing needs can be addressed efficiently and effectively to support their quality of life. There is very little evidence about the unmet needs of low‐ socioeconomic status (SES) breast cancer survivors. 8-10 These needs may differ considerably from the needs of other higher SES women affected by this disease; correlates of low‐SES include lower educa- tion, poverty, and poor health, which can impact how low‐SES breast cancer patients respond to their diagnosis and/or treatment. 11-13 Received: 21 September 2018 Revised: 12 February 2019 Accepted: 16 February 2019 DOI: 10.1002/pon.5035 1018© 2019 John Wiley & Sons, Ltd.Psycho‐Oncology. 2019;28:1018–1024. wileyonlinelibrary.com/journal/pon The aim of this study is to assess the needs of low‐SES breast cancer patients from the perspective of the patient and the provider. Qualita- tive interview methods were used to assess resource needs among low‐SES breast cancer patients in two different low‐resourced sites. We then interviewed providers from the same two sites who work with low‐SES breast cancer patients. 2 | METHODS Patients and providers were recruited from Boston Medical Center and the University of Tennessee Cancer Institute. These locations are safety‐net organizations that provide medical care and resources for the population of interest and areas where living beyond breast cancer (LBBC) has limited reach with the population. This study received the Fred Hutchinson Cancer Research Center Institutional Review Board (IRB) approval (reference number 9511). We focused on both patient and provider samples for these interviews because clinical impression provided support for the idea that these perspec- tives would be different in some key ways that could inform future intervention efforts. We include a consolidated criteria for reporting qualitative (COREQ) checklist in the Table S1. 2.1 | Patient recruitment We recruited 37 cancer patients overall (26 cancer patients, from Bos- ton, MA and 11 from Knoxville, TN). In Boston, community health workers from the Boston Public Housing Developments and Survivor- ship Staff from Boston Medical Center recruited patients via fliers, in person, or through medical records. Eligibility requirements included a diagnosis of breast cancer, received or receiving treatment from one of the medical centers, self‐identified as low income, and having completed no more than a high school education or living in public hous- ing. Interviews were scheduled with patients if they were both eligible and gave verbal consent to participate in the study. In Knoxville, we recruited patients by contacting the University of Tennessee Cancer Institute and local not‐for‐profit organizations, including support groups that provide resources to low‐income women with breast cancer. Interviews were scheduled with patients if they were both eligible and gave verbal consent to participate. Each interview took between 30 and 69 minutes. Authors JJ and ST conducted the reviews. 2.2 | Provider recruitment We also recruited providers and professionals that worked with low‐ SES breast cancer patients in Boston, MA and Knoxville, TN, including oncologists, nursing staff, health educators, and patient navigators. We invited these individuals to share their experiences via a semistructured telephone interview if they were eligible and gave verbal consent to participate. We also asked providers to refer us to other providers or professionals, using snowball sampling, who might be interested in participating in our study. Providers were eligible to participate if they had at least 5 hours of interaction with low‐SESbreast cancer patients per week and were employed at either Boston Medical Center or University of Tennessee Cancer Institute. We recruited four providers from each institution, resulting in a total of eight providers included in the study. 2.3 | Theoretical underpinnings We identified no overarching theory of how low SES potentially affects patient experiences. Therefore, we used a grounded theory approach to these interviews, which allowed us to identify elements of future theoretical models for subsequent research. The patient interview was semistructured and included topics such as finances, worries, and support programs and groups, among others. We also encouraged patients to discuss topics that were not prompted by the interviewer. We invited patients to share the met and unmet resource needs that existed during their experiences with or because of breast cancer. For providers, the interview guide included similar topics, such as finance, support programs and groups, and medical treatment, among others, affecting their low‐SES breast cancer patients; we also encouraged providers to discuss topics that were unprompted by the interviewer. Interview guides (please see Data S1 and S2) were reviewed for validity by providers and patients at each site to improve the quality of the interview guides. 2.4 | Analyses For both types of interviews, we stopped interviewing when we approached saturation within the interviews. We developed a draft coding manual to initiate the process of coding. We then piloted this manual with pilot interviews conducted for this purpose. We refined both the guide and the manual and applied it to three of the real inter- views to finalize it. Interviews were all audio‐recorded and transcribed, and two coders analyzed each type of transcript separately by hand using the initial draft of a coding guide, supplemented by codes iden- tified by coders and investigators during the coding process. The two coders discussed coding differences and resolved the conflicts until 80% agreement was reached. This was calculated with a simple miss/hit calculation. We compared rural versus urban and provider versus patient themes with visual inspection. 3 | RESULTS Table 1 presents demographic and background data on all patients. As seen in this table, most patients were women, with a mixture of ethnic backgrounds. All patients were low income because of eligibility criteria. Over half were not White, and less than half were married or partnered. Most (70%) were previously diagnosed with breast cancer. Table 2 presents a summary of the key themes that were discov- ered after analyzing the patient and provider transcripts, which are elaborated below. The key themes focus on finances, emotions, support groups meeting needs, support groups not meeting needs, the health care team, and social determinants of health. The key themes are separated into patient and provider perspectives. ENZLER ET AL .1019 3.1 | Common themes among patients Many cancer patients expressed difficulties or concerns that medical costs were a burden. Several patients described having to choose between medications and living expenses. “If it gets too bad, where I can’t pay for the medicine, then I weigh my option as [to] what I can get away with and what I can’t. Then, I pay for what helps me more…My finances have drastically changed a lot. That kinda weighs on me a lot.”‐Boston BC Patient Several times, patients stated that a cancer diagnosis negatively impacted their job or created difficulties in securing employment. Many patients had difficulty paying daily living expenses. “Financially, it was just hard, no real money coming in, so it was just a struggle for everything, food, utilities, everything that normal people would worry about.”‐ Knoxville BC PatientMany patients also expressed how treatment costs affected their ability to afford adequate housing or provide for their family. Living expenses that were commonly affected included rent, utilities, gas, and food. Several patients feared having to choose between living expenses and meeting treatment recommendations. Some patients mentioned having anxiety about future appointments because of limited money for transportation. One patient from Knoxville expressed anxiety about,“…how we were going to do everything, between the gas and the medicines and the doctors.” Some patients mentioned that breast cancer had multiple emo- tional impacts. One person stated,“I’m a very healthy person other than of course the cancer. I’ve been healthy my whole life, never smoked or anything. And you’re just—just sad.”Others mentioned that they were happy once treatment was over but felt depressed when thinking of how breast cancer impacted their life. One patient from Boston stated,“I was happy [after treatment]. I was happy, but I was also depressed because of what I went through.” Patients expressed several fears when told their diagnosis. Some of the patients felt that they did not know, at first, who or where to turn to for help, or what to expect after diagnosis. Several of the patients expressed fear of the unknown or experienced anxiety during appoint- ments. Many patients feared breast cancer recurrence. One patient stated that their fear of recurrence was,“something black that you have there. It’s fear that just shows up.”Several other patients worried about the cancer metastasizing. Several patients also mentioned that they eventually gathered strength to accept their diagnosis and move forward with treatment. One patient expressed,“I just took it as I need to just move forward with my life.”Other patients mentioned gathering strength by focus- ing on other health problems or the needs of their family. Some patients highlighted multiple ways that support groups and programs, both within the clinic and in the community, met their needs. Many patients mentioned how support groups provide a social aspect during their treatment, and several patients mentioned how strongly this need was met. “They have a website or a Facebook page where you can go and talk about your latest problem and they give you support from other cancer survivors and from nurses and things like that. It’s very supportive.”‐Knoxville BC Patient Many patients mentioned that the support groups and programs assisted with financial need. One patient stated,“…we got some finan- cial help through some of the organizations to help with the gas and the food.”Many patients also mentioned that the support groups and programs provide healthy opportunities, such as camping or white‐water rafting and personal development activities, such as painting or pottery. Some patients expressed that social support groups and programs provide opportunities for relaxation, such as yoga and opportunities to learn more information about breast cancer and treatment opportunities. A few patients mentioned how support groups and programs provide emotional support. Overall, many TABLE 1Demographic characteristics of cancer survivors who par- ticipated in interviews Characteristics Variables n, % Gender Male 3 (12) Female 23 (88) Race/Ethnicity Black/African American 13 (50) Hispanic/Latino 3 (12) 10 (28) White Age <40 2 (1) 40‐49 6 (15) 50‐59 9 (24) 60‐69 9 (24) >70 2 (1) Type of cancer Breast 26 (70) Cervical 2 (1) Colorectal 5 (13) Other 11 (16) Number of times diagnosed with cancer1 31 (84) 2 5 (13) 3 1 (1) Marital status Married/Domestic Partners 17 (46) Never Married 7 (19) Divorced 10 (27) Widow 3 (8) Education Less than high school 6 (23) High school or GED 7 (27) 1‐4 years at university/college 9 (34) Bachelor’s degree 4 (16) Master’s degree 0 Employment status Full T ime 2 (1) Part T ime 17 (46) Unemployed 18 (49) Abbreviation: GED, General Education Development. 1020ENZLER ET AL . patients expressed that nationally recognized cancer organizations support their needs, although some women felt that these organiza- tions were not helpful during their treatment. Patients expressed how participation in support groups and pro- grams did not meet several of their needs. Several patients mentioned that resources did not provide emotional support. One patient stated that support groups needed to provide,“…emotional support like apsychiatrist that’s available just for cancer patients.”Some patients also expressed inadequate preparation for what to do beyond treatment, such as obtaining prosthetics or developing a healthy lifestyle upon remission. Some patients mentioned that transportation was inadequate, which resulted in difficulty meeting treatment recom- mendations without private transportation. Several other patients mentioned that services did not provide support for families. One TABLE 2Comparison of key themes for patients and providers Key Themes Patient Perspective Provider Perspective Patient finances serve as barrier to high quality careMany patients expressed how cancer affected their ability to work, which negatively impacted their financial wellbeing. Many patients also expressed concerns with affording treatment, housing, and transportation. However, many patients expressed how resources within and outside of the hospital provided financial assistance, even if it did not fully meet their financial needs.Many Providers mentioned that cancer negatively affected patients’ finances, impacting rent, living expenses, and transportation. However, many providers also mentioned that most patients had insurance and that resources both within and outside the hospital provided funds to assist with medication and living expenses. Negative emotions hamper recoverySeveral cancer patients expressed happiness when treatment was over but felt sad when thinking about how much cancer had impacted their life. Many patients expressed fear or anxiety about the unknown, recurrence, or knowing what to do or who to turn to. Several patients expressed gathering strength and moving on.Many providers mentioned that patients expressed anxiety when thinking about paying for treatments and medication in addition to living expenses. Support groups available to helpMany cancer patients expressed how support groups and resources met several of their needs by offering financial assistance, emotional support, relaxation opportunities, and healthy activities.Many providers expressed that support groups and resources offered patients assistance with living expenses, transportation, medical expenses and prosthetics, and social support, as well as providing opportunities for relaxation and healthy activities. Support groups are inadequate to meet all needsSeveral cancer patients expressed how support groups and resources did not provide emotional support, adequate transportation options, guidance on what to do or expect past treatment, or support for family members.Several providers expressed that some of their patients did not or could not utilize support groups and resources offered to them. Health care team is important source of support and resourcesMany patients expressed receiving support from their oncologist and primary care doctor. Several expressed that the hospitals provided a supportive environment and that the medical team became like family to them. Several patients also expressed relying on their doctors for trustworthy information. However, several patients expressed feeling uninformed about their health or how to navigate medical resources. Several others expressed that they felt the medical team was disconnected and uncollaborative and that their PCP did not provide adequate support or information. Many patients felt uninformed about posttreatment expectations and expressed that their PCP assumed the patients wants and needs. Additionally, many patients felt that follow‐up appointments were burdensome either financially or as a time commitment.Several providers expressed that patients receive information about medical resources from social workers in the hospital. Several providers also expressed how the medical center was the main clinic for surrounding communities and provided the same quality of care as those received by higher SES populations. Social determinants of health impact care…Many providers expressed how limited funding constrained resources and that patient financial insecurity also contributes to inaccessibility of resources. Many providers expressed how education and wealth causes differences in health status or resource utilization between low‐SES and high‐SES cancer patients. Additionally, many providers expressed how low‐SES patients have fewer resources and support systems and that stress causes inaccessibility of resources. Some providers also expressed how the location of a patient’s residence can cause difficulty in accessing resources. Abbreviations: SES, low‐socioeconomic status; PCP, primary care provider. ENZLER ET AL .1021 patient mentioned that poorly managed family stress made their quality of life worse rather than better. “And as much as I feel like we’ve got a lot of family folks around. I don’t mean to disrespect the family people, but sometimes I think they make you more sick than what you are. They make you feel bad about this and that and you know. Sometimes, I don’t think people heal properly because of all the heavy stuff that they got on them.”‐Boson BC Patient Patients expressed both negative and positive perspectives of the medical team during treatment. Many patients expressed that the oncologist ensured their needs were met, and some patients also felt that their primary care doctor was supportive during their care. Several patients felt that the hospital provided a supportive environ- ment, and some patients viewed the medical team as family. Several patients mentioned relying on their doctors for trustworthy information. Several patients had negative experiences with their primary care providers (PCPs) or surrounding medical team. Several patients felt uninformed about their health and how to navigate medical resources; for example, one patient stated,“And sometimes I felt like I was not really informed enough about my health and insurance…”In addition, some patients felt that the medical team was disconnected or that medical teams in various specialties did not collaborate for the integrated health of the individual. Several patients felt very strongly that their PCP did not adequately explain treatments and were emotionally unavailable and unsupportive. “But that’s one of the, I guess, worst things. I think also the breast surgeons can probably be a little more—I remember that when my breast surgeon called me at work to tell me that I needed a mastectomy he was so blunt about it. There was no like not feeling or anything.”‐Knoxville BC Patient Many patients also felt strongly that PCPs did not inform them about posttreatment expectations. Some patients stated that their PCP assumed what they needed or wanted, such as prosthetics. One patient questioned her PCP’s assumptions by saying,“I was like did I say anything about wanting bigger breasts?”Several patients also noted that follow‐up appointments were burdensome for them, either financially or as a time commitment. 3.2 | Common themes among providers Table 2 presents a comparison between patient and provider themes. A prominent theme that providers discussed was patient financial burden. All providers expressed that patients had access to or were utilizing state sponsored insurance but whether this health coverage was sufficient for the needs of the patients varied by provider. Several providers mentioned that patients had adequate insurance while others felt that patients lacked adequate health coverage. Someproviders stated that insurance did not cover prosthetics needed by patients, such as lymphedema sleeves or cold caps. Most providers mentioned that breast cancer negatively affected patient’s living expenses. Several providers felt that breast cancer affected transportation. One provider highlighted how difficult it was for low‐SES breast cancer patients to afford transportation by stating, “…they can’t afford to either—can’t afford the gas or they can’t pay someone to bring them.”Many providers also mentioned how difficult it was for patients to pay rent or mortgage. “If you’re talking about comparing them to people who have higher…if you’re really putting your lens on SES level, those are some of the main challenges I’m seeing. Like really tangibly difficulties in both finances and in housing.”‐Boston BC Provider Providers expressed several similar perspectives of patient fear and methods of coping. Almost all providers strongly expressed that low‐SES patients typically experience more anxiety and fear when thinking about financing treatment in addition to current living expenses. “I will tell you that patients who come from disparate backgrounds tend to, in my estimate, in my experience, tend to worry much more about“How am I gonna pay for this.”‐Knoxville BC Provider Many providers expressed that current support groups and resources met many of the needs of the low‐SES populations. All providers mentioned that support programs helped breast cancer patients with living expenses, such as vouchers or money for food, utilities, and rent. “And when those needs were identified, then we provide things like…essentially cover folks utilities or rent or support for groceries or gas cards for transportation needs.”‐Knoxville BC Provider All providers also expressed, several of them strongly, that current resources connected patients with transportation services or offered financial assistance for transportation. One provider stated that a transportation method heavily utilized among patients allowed individ- uals to,“…arrange to have this bus come and pick them up from their house and bring them in to have their appointment.”Many providers also mentioned that offered resources addressed needs, including social support, relaxation, and opportunities for exercise and healthy living. Several providers stated that patients could access support for medical expenses and prosthetics through current resources. A few providers also expressed that church and religious groups were useful resources for low‐SES patients during treatment. Providers felt that local and national organizations outside of the medical center helped address low‐SES breast cancer patient needs. Many providers said that collaborating with organizations provided funds and resources that address patient needs. For example, Boston providers mentioned that the American Cancer Society previously sponsored a highly utilized event called“Look Good, Feel Better”that 1022ENZLER ET AL . helps low‐SES breast cancer patients obtain wigs and improve their self‐esteem. While many providers felt that patients could utilize resources and programs outside of the medical center, some providers felt that low‐SES breast cancer patients did not or were unable to utilize outside resources. Providers expressed that most commonly low‐SES breast cancer patients received information about medical resources and programs through a social worker within the clinic. Several providers mentioned that the medical center they worked at was the main clinic for the surrounding community and region. While these medical centers typically serve low‐SES populations, a few providers noted that the medical treatment is the same quality as the care given to higher‐SES populations. Several providers felt that the health status of low‐SES populations differed from those classified as higher‐SES; one provider mentioned that low‐SES individuals may not have access to a primary doctor,“…so they tend to come in with more advanced cancers.” Providers gave many reasons as to why low‐SES populations may have different needs than those with higher SES. Many providers felt that limited funding constrained current resources. Almost all providers strongly felt that patient financial insecurity contributes to inaccessibility of resources. “Well, I mean I think when you have a higher income, you don’t have any of the financial challenges that I just sort of outlined for you with regard to paying for your bills and having a home. Pay for your medicines, getting private health insurance, having access to care and usually having a financial buffer in your ability to take off work and go get your cancer treated.”‐Boston BC Provider Many providers also felt that social determinants of health, such as education or wealth, cause differences in health status or resource utilization between low‐SES and high‐SES breast cancer patients. Some providers mentioned that low‐SES populations have fewer resources available in the home, such as computers or private transportation options. Providers also stated that stress causes an inaccessibility of resources among low‐SES populations. Several providers felt strongly that low‐SES breast cancer patients have less support systems within their social network, which creates difficulty in obtaining needed resources. A few providers also mentioned that an individual’s location of residence may result in difficult accessing resources. 4 | CONCLUSIONS We wanted to discover unique needs of low‐SES breast cancer patients from both an urban and a rural setting by conducting interviews of these patients at the UT Cancer Institute and Boston Medical Center. The patient and provider perspectives we captured elucidated how low‐SES breast cancer patients have unique needs that differ from those of other breast cancer patients and how views of those needs differ between providers and patients. Resources offered at both Boston Medical Center and UT Cancer Institute were available to meet several low‐SES breast cancer patientneeds, such as living expenses and social support programs. These resources are critical in providing needed support. However, patients from both regions also expressed many unmet needs, while many pro- viders expressed the adequacy of meeting these needs for many patients. The gaps between providers and patients in perceptions of these unmet needs highlight a gap in current resource offerings from both locations. From these, data indicate that the linkages between patient and resources to meet all the needs are not adequate. Both low‐SES breast cancer patients and providers from both regions expressed met and unmet needs that were specific to each region, which demonstrates that resources are not spread universally nor are the wants and needs of low‐SES breast cancer patients equal across the country. As an example, low‐SES breast cancer patients and providers from Knoxville agreed that transportation was a large unmet need; however, low‐SES breast cancer patients and providers from Boston discussed that this was less of an issue for their region. Low‐SES breast cancer patients and providers from Boston, MA expressed that housing costs were a large barrier for individuals. While low‐SES breast cancer patients and providers from Knoxville, TN mentioned that individuals had financial difficulties, homelessness or eviction were more commonly expressed by patients from Boston, MA. These differences could reflect differences in the effects of rural versus urban poverty or differences in support offered by the institu- tions or something else entirely. A different assessment of these issues at multiple institutions might provide insight into the differ- ences reported here. There have been very few studies in the literature that focus solely on the needs of low‐SES breast cancer patients. Studies assessing the needs of breast cancer patients in the general population of breast cancer survivors present different themes than those collected by this study. In the general population of breast cancer patients, survivors face many needs as well that include psychological care, information about their disease, and coping mechanisms. 14-16 Low‐SES breast cancer patients in this study expressed some similar needs as those represented in other studies, but they also had greater pressing needs that were fundamental, including transportation options, financial assistance, and posttreatment support. This could suggest that low‐ SES breast cancer patients face more difficulty with basic needs than higher SES breast cancer patients. This also demonstrates that national and regional breast cancer nonprofit organizations could fill this gap in unmet needs and so support patients and providers better. Future direction should include advocating for increased funding to reduce resource gaps for low‐SES breast cancer patients and con- tinuing to research the unmet needs for this population. Providers need to maintain awareness of the diversity and complexities of needs for low‐SES patients, as current resource provision does not seem to cover all needs. As evidenced by this study, different regions may result in unique needs for low‐SES breast cancer patients. Future stud- ies should also assess why low‐SES breast cancer patients cannot access or use existing support programs and services, as these reasons may elucidate how to better serve this population without increasing costs. Low‐SES breast cancer patients also have unique and unmet needs beyond medical treatment. Improving resources outside of ENZLER ET AL .1023 medical treatment may allow low‐SES breast cancer patients to better adhere to treatment or improve their health that has positive implica- tions for health care expenditures. 4.1 | Clinical implications These data indicate that there is more to be done to meet the needs of low‐SES breast cancer patients. But more resources and dollars will not completely fill the gaps observed. One implication is to better connect the patients with the resources available, through multiple communication channels, depending on the population. More long‐ distance resources might be made available for rural women or women with transportation difficulties. Women at both sites expressed feeling left out or disconnected from a more human touch. Perhaps peer or navigator driven resources can be employed to fill that void. Providers should not assume that because a resource was offered, it will be perceived by the patients as available, free, and accessible. 4.2 | Limitations The study had limitations that constrain the generalizability of the findings. First, it was conducted in two specific geographic locations that do not represent a population of low‐SES breast cancer patients. The qualitative nature of the study prohibits us from assessing rates of distress or concurrence between patients and providers. Finally, we did not measure these issues over time, and a longitudinal study might have identified changes that changed with distance from treatment. Given the target of low‐SES women, we did not think measuring SES in participants was necessary, but even among these women, it is pos- sible to imagine variation in SES that could alter responding. All of these could be addressed through future research. Numbers do not total 100% because of missing data. 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Difference of patient’s perceived need in breast cancer patients after diagnosis.Jpn J Clin Oncol. 2015;45(1):75‐80. 15. Degner LF, Kristjanson LJ, Bowman D, et al. Information Needs and Decisional Preferences in Women With Breast Cancer.JAMA. 1997;277(18):1485‐1492. 16. Thewes B, Butow P, Girgis A, Pendlebury S. Assessment of Unmet Needs Among Survivors of Breast Cancer.J Psychosoc Oncol. 2004; 22(1):51‐73. SUPPORTING INFORMATION Additional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article:Enzler CJ, Torres S, Jabson J, Ahlum Hanson A, Bowen DJ. Comparing provider and patient views of issues for low‐resourced breast cancer patients.Psycho‐ Oncology. 2019;28:1018–1024. https://doi.org/10.1002/ pon.5035 1024ENZLER ET AL .