Research ArticleResearchPatient Education

Decision coaching helped more undecided BRCA carriers reach a preventive decision

PloS one (PubMed)Aug 17, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

An exploratory randomized-trial subgroup analysis found that structured decision coaching helped more initially undecided BRCA1/2 carriers with open family planning reach a preventive-care decision than usual care.

What NurseJet pulled from the source

Participants without a personal cancer history received usual care or in-person coaching plus an evidence-based decision aid covering intensified breast surveillance, risk-reducing mastectomy, and risk-reducing salpingo-oophorectomy. Among initially undecided participants with open family planning, 61.8% in the intervention group versus 23.3% with usual care had reached a decision at 12 weeks.

Why this matters for nurses

Oncology nurses often help patients navigate hereditary-cancer information, competing reproductive priorities, and emotionally difficult preventive choices. The study supports structured decision support while preserving the patient's values and avoiding pressure toward a particular operation or surveillance plan.

Bedside takeaway

Structured coaching can reduce BRCA-related decision conflict while keeping surveillance, surgery, and reproductive timing centered on informed patient preferences.

How This Applies in Practice

Use this when: Supporting a BRCA1/2 carrier without cancer who is weighing preventive options while family planning remains open.

On your shift

Assess the patient's current understanding, preferred role in decisions, unanswered questions, and how reproductive goals affect timing.
Offer the organization's approved decision aid and connect the patient with genetics, oncology, gynecology, or fertility counseling as appropriate.
Document preferences and decisional uncertainty separately from consent, and arrange follow-up when the patient is not ready to decide.

Keep in mind: The study evaluated decision support, not which preventive choice is best. Follow the multidisciplinary plan, facility policy, and provider orders.

Key takeaways

BRCA1/2 carriers with open family planning began with greater decisional conflict than those who had completed family planning.
Decision coaching combined an in-person session with a structured, evidence-based aid describing preventive options.
Among initially undecided participants with open family planning, more reached a preventive decision by 12 weeks with coaching than with usual care.
The analysis was exploratory and assessed decision process outcomes, not cancer incidence, survival, or the clinical superiority of any option.

Practice implications

Clarify what the patient understands about each option, ask how family-planning goals affect timing, and connect unresolved questions to genetics, oncology, gynecology, or fertility specialists through the established pathway. Document preferences and uncertainty without presenting decision completion as consent for a specific intervention.

Limitations & cautions

This was an exploratory subgroup analysis of a randomized trial, and the abstract does not report subgroup size or long-term clinical outcomes. Reaching a decision does not establish that the decision was durable, preferred later, or medically superior.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations

Exact source links

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PloS one (PubMed)

PloS one (PubMed). Decision coaching for healthy women with BRCA1/2 pathogenic variants and open family planning: Impact on decisional conflict and decision status: Subgroup analyses from a randomized controlled trial.

Open original source

https://pubmed.ncbi.nlm.nih.gov/42607047/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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Obstetrics and gynecology (PubMed)Oct 1, 2026Systematic Review

A systematic review and meta-analysis of 30 US studies found doula support during pregnancy, childbirth, and postpartum was associated with lower rates of preterm birth and cesarean delivery, improved birth experiences, and higher postpartum visit attendance.

L&D / OB Med-SurgAI summaryReview source

Systematic ReviewResearchPatient EducationAI summary · original source linked below

Continuous non-clinical labor support has drawn increasing interest to address severe maternal health disparities and high obstetric intervention rates across the United States. This systematic review and meta-analysis evaluated 30 US-based studies (12 randomized controlled trials and 18 nonrandomized studies of interventions) examining doula care compared with standard maternity care. Using GRADE methodology, the investigators found moderate-certainty evidence that doula support is likely associated with lower rates of preterm birth, decreased cesarean delivery, improved maternal birth experiences, and higher postpartum visit attendance. Low-certainty evidence suggested potential associations with improved prenatal mood, increased spontaneous vaginal birth and vaginal birth after cesarean (VBAC), earlier breastfeeding initiation, reduced epidural analgesia use, shorter labor duration, and lower infant mortality. Doula support was not associated with reductions in hypertensive disorders of pregnancy, maternal readmissions, or NICU admissions. Notably, four of five studies focusing specifically on populations experiencing structural disparities (by race, incarceration, low income, or Medicaid insurance) documented positive maternal-infant benefits.

Key takeaways

Systematic review synthesized 12 RCTs and 18 nonrandomized studies evaluating US doula support.
Moderate-certainty evidence links doula support to lower rates of preterm birth and cesarean delivery.
Doula care was associated with improved maternal birth experience and increased postpartum appointment attendance.
Four of five studies in populations facing structural health disparities reported measurable benefits from doula collaboration.

Why this matters on shift

Labor and delivery and postpartum nurses work directly alongside doulas at the bedside to promote physiological birth, manage labor discomfort, and advocate for patient autonomy. High-level evidence validating that doula support reduces operative deliveries and bolsters postpartum follow-up reinforces collaborative, respectful interprofessional nursing practice.

Bedside takeaway

In a meta-analysis of 30 US studies, doula support was linked to lower preterm birth and cesarean rates, better birth experiences, and higher postpartum visit attendance (moderate certainty).

Nursing implications

Welcome community and hospital-based doulas into labor suites as valued members of the birth support team, coordinate non-pharmacological comfort measures collaboratively, and encourage postpartum follow-up engagement during pre-discharge teaching.

Limitations & cautions

Nineteen of the 30 included studies had high risk of bias; considerable heterogeneity was observed across clinical outcomes; data regarding the optimal timing, dose, and model of doula care were limited.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Obstetrics and gynecology (PubMed). Doula Support During Pregnancy, Childbirth, and Postpartum: A Systematic Review and Meta-Analysis.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

Journal of clinical oncology (PubMed)Sep 16, 2026Research Article

In the MATCH comparative effectiveness trial of 587 cancer survivors, both mindfulness-based cancer recovery and Tai Chi/Qigong significantly reduced post-treatment fatigue and pain interference compared to controls, with Tai Chi also significantly improving sleep quality.

Oncology Med-SurgAI summaryReview source

Research ArticleResearchPatient EducationAI summary · original source linked below

Cancer survivors frequently experience a distressing co-occurring symptom cluster of persistent fatigue, sleep disruption, and chronic pain following primary therapy. The MATCH trial (Mindfulness and Tai Chi for Cancer Health) was a partially randomized patient-preference comparative effectiveness trial evaluating Mindfulness-Based Cancer Recovery (MBCR) and Tai Chi/Qigong (TCQ) in distressed cancer survivors across diverse cancer diagnoses and stages. Enrolled participants (N = 587; mean age 60.7 years) either chose an intervention or underwent randomization to MBCR or TCQ, followed by secondary randomization to immediate intervention or waitlist control. At post-intervention, both MBCR and TCQ produced statistically significant reductions in fatigue compared to waitlist controls, with mean improvements of 3.66 points (P = .036) and 3.42 points (P = .043), respectively. Pain interference improved by more than 1 point in both active groups (MBCR: P = .029; TCQ: P = .002). TCQ also yielded a statistically significant 1.9-point improvement on the sleep quality scale after multivariable adjustment (P = .004). Clinical outcomes did not differ between MBCR and TCQ, and participant preference status did not affect intervention efficacy.

Key takeaways

Partially randomized patient-preference trial enrolled 587 distressed cancer survivors across multiple tumor types and disease stages.
Both mindfulness (MBCR) and movement-based Tai Chi (TCQ) produced statistically significant improvements in cancer-related fatigue (P = .036 and P = .043).
Both interventions achieved meaningful reductions of greater than 1 point in chronic pain interference (P = .029 and P = .002).
Tai Chi uniquely achieved a statistically significant 1.9-point improvement in overall sleep quality scale scores (P = .004).

Why this matters on shift

Oncology and outpatient clinic nurses frequently support cancer survivors struggling with debilitating symptom clusters that persist long after chemotherapy and radiation end. Confirming that both structured mindfulness and Tai Chi offer comparable, evidence-based relief for fatigue and pain interference equips nurses to guide patients toward integrative therapies matching their physical mobility and lifestyle preferences.

Bedside takeaway

In a 587-patient trial of cancer survivors, both mindfulness (MBCR) and tai chi (TCQ) significantly reduced post-treatment fatigue (p=0.036 and p=0.043) and pain interference (p=0.029 and p=0.002), with tai chi also improving sleep quality (p=0.004).

Nursing implications

Screen cancer survivors routinely for clustered symptoms of fatigue, pain, and insomnia, and discuss evidence-backed integrative referrals such as mindfulness-based recovery or Tai Chi as non-pharmacological adjuncts to symptom management.

Limitations & cautions

Partially randomized design allowed patient preference selection; waitlist comparison group rather than active sham control; symptom endpoints relied on patient-reported validated scales.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Journal of clinical oncology (PubMed). Mindfulness and Tai Chi for Sleep, Fatigue, and Pain in Distressed People After Cancer Treatment: A Partially Randomized Patient-Preference Comparative Effectiveness Trial.

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AI-summarized from the linked source. Review the original article before applying to practice.

Intensive care medicine (PubMed)Oct 1, 2026Research Article

The 18-center TRANSPORT randomized trial of 187 cancer patients with septic shock found that a liberal transfusion strategy (Hb threshold 9.0 g/dL) did not improve 12-hour lactate clearance (52% vs 50%) or 28-day survival over a restrictive strategy (Hb threshold 7.0 g/dL), but increased thrombotic events from 1% to 13%.

ICU OncologyAI summaryReview source

Research ArticleResearchMedication SafetyQuality ImprovementAI summary · original source linked below

Septic shock carries high mortality among oncology patients, in whom severe anemia frequently prompts clinician concern regarding systemic tissue hypoxia. The multicenter TRANSPORT superiority randomized trial, conducted across 18 intensive care units in France, evaluated whether an early liberal red blood cell transfusion threshold (hemoglobin target 9.0 g/dL, n=93) improved tissue perfusion compared to a restrictive threshold (hemoglobin target 7.0 g/dL, n=94) during the initial 48 hours of resuscitation in adult cancer patients with septic shock (baseline lactate > 2.0 mmol/L and Hb < 9.0 g/dL). The trial was stopped prematurely for safety concerns after enrolling 187 of a planned 260 patients. Twelve-hour lactate reduction (normalization <= 2.0 mmol/L or >= 30% decrease) showed no difference between arms (52% liberal vs 50% restrictive; odds ratio 1.07; 95% CI 0.60 to 1.90; P = 0.82). Arterial or venous thrombotic complications occurred significantly more often in the liberal group (13% vs 1%; P = 0.001), while 28-day mortality remained comparable (46% liberal vs 53% restrictive; P = 0.34).

Key takeaways

Multicenter randomized trial in 18 French ICUs evaluated transfusion thresholds during initial 48 hours of septic shock in cancer patients.
Trial halted prematurely at 187 patients due to safety imbalances between study arms.
Liberal transfusion (Hb < 9.0 g/dL) failed to improve 12-hour lactate clearance (52% vs 50%, P = 0.82) or 28-day mortality (46% vs 53%, P = 0.34).
Liberal transfusion was associated with a marked increase in arterial and venous thrombotic events (13% vs 1%, P = 0.001).

Why this matters on shift

Bedside critical care nurses frequently administer blood transfusions in septic shock and monitor for complications. These findings reinforce that higher hemoglobin targets do not accelerate shock resolution even in high-risk oncology patients, and alert nurses to the substantial thrombotic hazard of unneeded liberal transfusions.

Bedside takeaway

In cancer patients with septic shock, liberal transfusion (Hb <9 g/dL) did not improve lactate clearance or 28-day survival over restrictive transfusion (Hb <7 g/dL) but raised thrombotic complications from 1% to 13%.

Nursing implications

Adhere strictly to restrictive transfusion thresholds (hemoglobin < 7.0 g/dL) during septic shock resuscitation unless provider orders or institutional protocol dictate otherwise, and maintain heightened surveillance for deep vein thrombosis or arterial occlusion if liberal transfusions are administered.

Limitations & cautions

Premature termination resulted in underpowered final sample size (187 enrolled of 260 planned); conducted exclusively within French intensive care units; limited to adult hematologic and solid oncology patients.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Intensive care medicine (PubMed). Early red blood cell transfusion strategy in septic shock among patients with cancer: the TRANSPORT randomized controlled trial.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

How This Applies in Practice

Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

Systematic review and meta-analysis finds doula support linked to lower preterm birth and cesarean delivery rates

MATCH trial of 587 cancer survivors shows mindfulness and tai chi significantly alleviate post-treatment fatigue and pain interference

TRANSPORT multicenter trial in cancer patients with septic shock finds liberal transfusion offers no lactate or survival benefit but increases thrombosis