The Attitudes, Communication, Treatment and Support Intervention to Reduce Breast Cancer Treatment Disparity

Midpoint chemotherapy adherence was measured by recording the chemotherapy dose received/chemotherapy dose prescribed at the treatment midpoint via medical record review for each participant in both the ACTS Intervention and Usual Care groups.

Endpoint chemotherapy adherence was measured by recording the chemotherapy dose received/chemotherapy dose prescribed at the treatment endpoint via medical record review for each participant in both the ACTS Intervention and Usual Care groups.

Social Support will be assessed with the Interpersonal Support Evaluation List (ISEL-12), the shortened general population form. The ISEL was designed to assess the perceived availability of four separate functions of social support as well as providing an overall support measure. The items which comprise the ISEL fall into four 10-item subscales listed as tangible, appraisal, self esteem and belonging. Scoring is based on a 5 point Likert scale test-retest data reveal correlations between .77-.86 Cronbach alpha = .86

Symptom Occurrence and Severity Measure: The McCorkle Symptom Distress Scale (SDS) was developed in 1977 based on interviews with patients about their symptom experiences. Scores range from 1 to 5 on a Likert-type scale with 5 indicating most severe.157 Total symptom distress can be obtained as the unweighted sum of 13 items. If an item is scored as 3 or above it is considered to indicate serious distress. A cumulative score of 25 or more indicates moderate distress and any score above 33 indicates severe distress necessitating immediate intervention.149 The SDS can be administered as paper questionnaire.

Symptom Occurrence and Severity Measure: The McCorkle Symptom Distress Scale (SDS) was developed in 1977 based on interviews with patients about their symptom experiences. Scores range from 1 to 5 on a Likert-type scale with 5 indicating most severe.157 Total symptom distress can be obtained as the unweighted sum of 13 items. If an item is scored as 3 or above it is considered to indicate serious distress. A cumulative score of 25 or more indicates moderate distress and any score above 33 indicates severe distress necessitating immediate intervention.149 The SDS can be administered as paper questionnaire.

Twenty two symptoms are assessed. If present, the patient is then asked if they reported the symptom to their doctor or nurse and if they received recommendations made by the health care team. The psychometrics for this instrument are not established. This instrument measures a key component of the ACTS Intervention, the ability to communicate distress to health care professionals. Scoring is dichotomous (yes/no) for experiencing the symptom and yes/no spoke with physician or nurse about that symptom. Total score is number of symptoms reported over number of symptoms total.

The Functional Assessment of Cancer Therapy is a 27- item self-report Likert scale questionnaire comprising four subscales-physical well being, social well being, functional well-being, and emotional well-being The FACT is designed to measure health-related quality of life for individuals with cancer.147 Each item is rated from on a scale of zero to four with zero equal to "not at all" and four equal to "very much." This questionnaire requires 5-7 minutes to complete. It has been determined appropriate for use in clinical oncology settings and shown to have good validity and reliability.148 In initial psychometric evaluation, the mean score for the FACT- G was 82.05 (SD 15.86)