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Wilson M, Rankin K, Ludi D, Sweeny K. Emotional, cognitive, and physical well-being during the wait for breast biopsy results. Psychol Health 2024; 39:858-877. [PMID: 36047680 DOI: 10.1080/08870446.2022.2117811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 07/21/2022] [Accepted: 08/22/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE This study is a replication and extension of previous work examining the well-being of patients at a breast biopsy appointment. Expanding on a previous study, we aim to identify predictors of well-being following the appointment (i.e. waiting for results). DESIGN In this longitudinal study, female patients (N = 197) were surveyed at their breast biopsy appointments and then completed daily surveys assessing distress and coping during the week-long wait for results. MAIN OUTCOME MEASURES Surveys asked about patient characteristics, subjective health, cancer history, support availability, outcome expectations, and distress. RESULTS/CONCLUSIONS Consistent with the previous study, health history and demographic factors were largely unassociated with distress, this time while waiting for biopsy results. Latina ethnicity emerged one of the few predictors of coping, pointing to opportunities for differential clinical interventions that take cultural factors into account. Finally, anxiety was highest at the beginning and end of the wait for biopsy results, suggesting that interventions may be most effective following a breast biopsy and the days prior to learning one's result.
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Affiliation(s)
- Melissa Wilson
- Department of Psychology, University of California, Riverside, Riverside, CA, USA
| | - Kyla Rankin
- Department of Psychology, Moreno Valley College, Moreno Valley, CA, USA
| | - Daniel Ludi
- Department of Surgery, Riverside University Health System, Moreno Valley, CA, USA
| | - Kate Sweeny
- Department of Psychology, University of California, Riverside, Riverside, CA, USA
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2
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Moreno PI, Worch SM, Thomas JL, Nguyen RL, Medina HN, Penedo FJ, Moskowitz JT, Yanez B, Kircher SM, Kundu SD, Flury SC, Cheung EO. Quality of Life in Patients and Their Spouses and Cohabitating Partners in the Year Following a Cancer Biopsy (the Couples Cope Study): Protocol for a Prospective Observational Study. JMIR Res Protoc 2024; 13:e52361. [PMID: 38889402 PMCID: PMC11220434 DOI: 10.2196/52361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Receiving a diagnosis of cancer is a profound and often very stressful experience. Few studies have prospectively recruited patients prior to receiving a new diagnosis of cancer and included spouses or partners. OBJECTIVE The aim of the Couples Cope Study is to understand the impact of undergoing a diagnostic biopsy and receiving a new cancer diagnosis on quality of life (QoL) in both patients and their spouses or partners, as well as on the quality of their relationship. This protocol paper describes the study design and assesses the feasibility of recruitment and retention. METHODS Study staff reviewed the schedules of collaborating physicians using specific encounter codes to identify patients scheduled for breast or prostate biopsies. Potential participants were prescreened via the electronic health record and sent a recruitment letter at least 2 to 3 weeks prior to their biopsy procedure. Patients subsequently underwent a phone screening to determine eligibility. Patients who enrolled provided study staff with contact information for their spouses or partners. All consent forms were completed online. Surveys were completed online prior to receiving the biopsy results (baseline), and at 1, 3, 6, and 9 months after the biopsy. Study staff engaged in ongoing, personalized contact with participants and sent assessment completion reminders via phone and email. RESULTS A total of 2294 patients undergoing a breast or prostate biopsy were identified and 69% (n=1582) were eligible for phone screening following electronic health record prescreening. Of the 431 patients who underwent phone screening, 75% (n=321) were eligible to participate. Of the eligible patients, 72% (n=231) enrolled and 82% (n=190) of enrolled patients had an accompanying partner or spouse who also enrolled. A total of 77% (34/44) of patients who received a cancer diagnosis and 72% (26/36) of their spouses or partners were retained through 9 months, while 80% (53/66) of patients who received a benign diagnosis and 68% (42/62) of their partners were retained. CONCLUSIONS Prospective recruitment of patients undergoing diagnostic biopsy and their partners is feasible and requires both strategic collaboration with providers and concerted prescreening and recruitment efforts by study staff. Importantly, this study was able to conduct all study activities online without disrupting clinical workflow and without requiring patients and their spouses or partners to come into the laboratory. Consideration should be given to the ratio of biopsies to cancer diagnoses, which can vary significantly by cancer type. Prospective studies are needed and can inform our ability to provide effective support earlier to couples facing a possible cancer diagnosis. Future studies should examine other tumor types that have received less attention in QoL studies, include behavioral and neurobiological assessments beyond self-report measures, and follow couples beyond 9 months in order to examine long-term effects on QoL. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52361.
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Affiliation(s)
- Patricia I Moreno
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Sarah M Worch
- Department of Psychology, Lynn University, Boca Raton, FL, United States
| | - Jessica L Thomas
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Rebecca L Nguyen
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD, United States
| | - Heidy N Medina
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Frank J Penedo
- Departments of Medicine & Psychology, University of Miami, Miami, FL, United States
| | - Judith T Moskowitz
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sheetal M Kircher
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Shilajit D Kundu
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sarah C Flury
- Department of Urology, Vanderbilt University School of Medicine, Nashville, TN, United States
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Grimm LJ, Shelby RA, Destounis SV, Knippa EE, Langman EL, Nedrud MA, Musick A, Yoon S, Johnson K, Baker J, Taylor-Cho M, Soo MS. Now or Later? Patient Satisfaction and Anxiety Among Women Undergoing Breast Biopsies Performed the Same Day as Recommended Versus a Later Day. J Am Coll Radiol 2024; 21:415-424. [PMID: 37820836 DOI: 10.1016/j.jacr.2023.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/03/2023] [Accepted: 07/18/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE The aim of this study was to determine differences in patient satisfaction and anxiety among women undergoing core-needle breast biopsies performed the same day as recommended versus a future date. METHODS After institutional review board exemption was granted, a survey was administered to patients at four sites on the day of imaging-guided core-needle breast biopsy. The survey was available from November 2020 through January 2022. Questions pertained to biopsy timing (same day versus later day), pre- and postbiopsy satisfaction with overall breast-care experience, biopsy wait-time satisfaction, pre- and postbiopsy anxiety, radiologist-patient communication, demographics, life stressors, breast cancer history, and risk factors. Comparisons were made between same-day and later-day biopsies by multivariable analysis. RESULTS Of 974 respondents (response rate 65.6%), almost half were scheduled for same-day biopsies (47.8% [466 of 974]). In multivariate analyses, same-day biopsies were associated with higher prebiopsy overall breast-care satisfaction (P < .001), higher wait-time satisfaction (P < .001), and higher prebiopsy (P = .001) and postbiopsy anxiety (P = .001). Better radiologist-patient communication was associated with lower prebiopsy anxiety (P < .001) and greater prebiopsy overall (P < .001) and wait-time (P < .001) satisfaction. Compared with White women, Black women reported lower postbiopsy anxiety (P < .001) but also lower prebiopsy satisfaction (P = .03) and wait-time satisfaction (P < .001). CONCLUSIONS Same-day versus later-day biopsies resulted in better prebiopsy overall breast-care and wait-time patient satisfaction scores; however, no satisfaction differences were noted after biopsy. Clinically significant anxiety was associated with both same- and later-day biopsies but was higher for same-day biopsies. Higher anxiety levels correlated with lower overall satisfaction, suggesting that interventions to reduce anxiety and improve communication could improve patient experiences during same-day biopsies.
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Affiliation(s)
- Lars J Grimm
- Department of Radiology, Duke University, North Carolina.
| | - Rebecca A Shelby
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
| | | | - Emily E Knippa
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Eun L Langman
- Department of Radiology, Duke University, North Carolina
| | | | | | - Sora Yoon
- Department of Radiology, Duke University, North Carolina
| | - Karen Johnson
- Department of Radiology, Duke University, North Carolina
| | - Jay Baker
- Vice Chair, Department of Radiology, Duke University, North Carolina
| | | | - Mary Scott Soo
- Department of Radiology, Duke University, North Carolina
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Fortin J, Rivest-Beauregard M, Defer C, Leblanc M, Thamar Louis LA, Roy CA, Lapierre I, Brunet A, Montreuil M, Marin MF. The Impact of Canadian Medical Delays and Preventive Measures on Breast Cancer Experience: A Silent Battle Masked by the COVID-19 Pandemic. Can J Nurs Res 2023; 55:55-67. [PMID: 35484788 PMCID: PMC9086203 DOI: 10.1177/08445621221097520] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic led to the prioritization of breast cancer services towards patients who are currently in treatment or diagnosed with advanced stages of breast cancer, and the self-assessment of both tumor growth and treatment side effects. Alongside the stress associated with cancer itself, delays and complications due to COVID-19 may impact patients' mental health. PURPOSE To describe the experiences of Canadians living with breast cancer who received a diagnosis and/or treatment during the pandemic, and to identify their recommendations for improving patients well-being during future pandemics. METHODS Semi-structured interviews were conducted with eighteen women living with breast cancer who also completed the Distress Thermometer questionnaire. The transcripts were analyzed using a descriptive thematic content methodology. RESULTS Women who started their breast cancer screening or treatment before the pandemic reported fewer delays and less psychological distress than those who started during the pandemic. Participants reported feeling dehumanized while receiving their medical care, being unable to be accompanied during medical visits, and fearing treatment interruption during the pandemic. Patient recommendations for improving care and psychological support included the presence of family caregivers at consultations to receive the diagnosis and for the first treatment session. CONCLUSION Study findings provide new insights on how healthcare restrictions during the pandemic impacted on patient experiences and their well-being during screening and treatment for breast cancer. The need for cancer nursing practices and care delivery strategies that promote the delivery of compassionate, patient-centred care and the provision of psychological support during future pandemics are identified.
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Affiliation(s)
- Justine Fortin
- Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada,Centre de recherche de l’Institut en santé mentale de Montréal, CIUSSS-de-l’Est-de-l’Île-de-Montréal, Montreal, Quebec, Canada,Justine Fortin, 7331, rue Hochelaga Montréal, Québec, H1N 3V2, Canada.
| | | | - Clarisse Defer
- Department of Oncology, Hôpital Maisonneuve-Rosemont (CIUSSS-de-l’Est-de-l’Île-de-Montréal), Montreal, Quebec, Canada
| | | | | | - Carol-Anne Roy
- Department of Psychology, Université du Québec en Outaouais, Montreal, Quebec, Canada
| | | | - Alain Brunet
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Marjorie Montreuil
- Centre de recherche de l’Institut en santé mentale de Montréal, CIUSSS-de-l’Est-de-l’Île-de-Montréal, Montreal, Quebec, Canada,Department of Nursing, McGill University, Montreal, Quebec, Canada
| | - Marie-France Marin
- Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada,Centre de recherche de l’Institut en santé mentale de Montréal, CIUSSS-de-l’Est-de-l’Île-de-Montréal, Montreal, Quebec, Canada
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Lawson MB, Bissell MCS, Miglioretti DL, Eavey J, Chapman CH, Mandelblatt JS, Onega T, Henderson LM, Rauscher GH, Kerlikowske K, Sprague BL, Bowles EJA, Gard CC, Parsian S, Lee CI. Multilevel Factors Associated With Time to Biopsy After Abnormal Screening Mammography Results by Race and Ethnicity. JAMA Oncol 2022; 8:1115-1126. [PMID: 35737381 PMCID: PMC9227677 DOI: 10.1001/jamaoncol.2022.1990] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Importance Diagnostic delays in breast cancer detection may be associated with later-stage disease and higher anxiety, but data on multilevel factors associated with diagnostic delay are limited. Objective To evaluate individual-, neighborhood-, and health care-level factors associated with differences in time from abnormal screening to biopsy among racial and ethnic groups. Design, Setting, and Participants This prospective cohort study used data from women aged 40 to 79 years who had abnormal results in screening mammograms conducted in 109 imaging facilities across 6 US states between 2009 and 2019. Data were analyzed from February 21 to November 4, 2021. Exposures Individual-level factors included self-reported race and ethnicity, age, family history of breast cancer, breast density, previous breast biopsy, and time since last mammogram; neighborhood-level factors included geocoded education and income based on residential zip codes and rurality; and health care-level factors included mammogram modality, screening facility academic affiliation, and facility onsite biopsy service availability. Data were also assessed by examination year. Main Outcome and Measures The main outcome was unadjusted and adjusted relative risk (RR) of no biopsy within 30, 60, and 90 days using sequential log-binomial regression models. A secondary outcome was unadjusted and adjusted median time to biopsy using accelerated failure time models. Results A total of 45 186 women (median [IQR] age at screening, 56 [48-65] years) with 46 185 screening mammograms with abnormal results were included. Of screening mammograms with abnormal results recommended for biopsy, 15 969 (34.6%) were not resolved within 30 days, 7493 (16.2%) were not resolved within 60 days, and 5634 (12.2%) were not resolved within 90 days. Compared with White women, there was increased risk of no biopsy within 30 and 60 days for Asian (30 days: RR, 1.66; 95% CI, 1.31-2.10; 60 days: RR, 1.58; 95% CI, 1.15-2.18), Black (30 days: RR, 1.52; 95% CI, 1.30-1.78; 60 days: 1.39; 95% CI, 1.22-1.60), and Hispanic (30 days: RR, 1.50; 95% CI, 1.24-1.81; 60 days: 1.38; 95% CI, 1.11-1.71) women; however, the unadjusted risk of no biopsy within 90 days only persisted significantly for Black women (RR, 1.28; 95% CI, 1.11-1.47). Sequential adjustment for selected individual-, neighborhood-, and health care-level factors, exclusive of screening facility, did not substantially change the risk of no biopsy within 90 days for Black women (RR, 1.27; 95% CI, 1.12-1.44). After additionally adjusting for screening facility, the increased risk for Black women persisted but showed a modest decrease (RR, 1.20; 95% CI, 1.08-1.34). Conclusions and Relevance In this cohort study involving a diverse cohort of US women recommended for biopsy after abnormal results on screening mammography, Black women were the most likely to experience delays to diagnostic resolution after adjusting for multilevel factors. These results suggest that adjustment for multilevel factors did not entirely account for differences in time to breast biopsy, but unmeasured factors, such as systemic racism and other health care system factors, may impact timely diagnosis.
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Affiliation(s)
- Marissa B. Lawson
- Department of Radiology, University of Washington School of Medicine, Seattle
| | - Michael C. S. Bissell
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis
| | - Diana L. Miglioretti
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis,Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Joanna Eavey
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Christina H. Chapman
- Department of Radiation Oncology, Michigan Medicine, Ann Arbor,University of Wisconsin–Madison School of Medicine and Public Health, Madison
| | - Jeanne S. Mandelblatt
- Department of Oncology, Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
| | - Tracy Onega
- Department of Population Health Sciences, University of Utah, Huntsman Cancer Institute, Salt Lake City
| | - Louise M. Henderson
- Departments of Radiology and Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill
| | - Garth H. Rauscher
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco,General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco
| | - Brian L. Sprague
- Departments of Surgery and Radiology, University of Vermont Cancer Center, University of Vermont, Burlington
| | - Erin J. A. Bowles
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Charlotte C. Gard
- Department of Economics, Applied Statistics, and International Business, New Mexico State University, Las Cruces
| | | | - Christoph I. Lee
- Department of Radiology, University of Washington School of Medicine, Seattle,Department of Health Services, University of Washington School of Public Health, Seattle
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Brahimetaj R, Willekens I, Massart A, Forsyth R, Cornelis J, Mey JD, Jansen B. Improved automated early detection of breast cancer based on high resolution 3D micro-CT microcalcification images. BMC Cancer 2022; 22:162. [PMID: 35148703 PMCID: PMC8832731 DOI: 10.1186/s12885-021-09133-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 12/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The detection of suspicious microcalcifications on mammography represents one of the earliest signs of a malignant breast tumor. Assessing microcalcifications' characteristics based on their appearance on 2D breast imaging modalities is in many cases challenging for radiologists. The aims of this study were to: (a) analyse the association of shape and texture properties of breast microcalcifications (extracted by scanning breast tissue with a high resolution 3D scanner) with malignancy, (b) evaluate microcalcifications' potential to diagnose benign/malignant patients. METHODS Biopsy samples of 94 female patients with suspicious microcalcifications detected during a mammography, were scanned using a micro-CT scanner at a resolution of 9 μm. Several preprocessing techniques were applied on 3504 extracted microcalcifications. A high amount of radiomic features were extracted in an attempt to capture differences among microcalcifications occurring in benign and malignant lesions. Machine learning algorithms were used to diagnose: (a) individual microcalcifications, (b) samples. For the samples, several methodologies to combine individual microcalcification results into sample results were evaluated. RESULTS We could classify individual microcalcifications with 77.32% accuracy, 61.15% sensitivity and 89.76% specificity. At the sample level diagnosis, we achieved an accuracy of 84.04%, sensitivity of 86.27% and specificity of 81.39%. CONCLUSIONS By studying microcalcifications' characteristics at a level of details beyond what is currently possible by using conventional breast imaging modalities, our classification results demonstrated a strong association between breast microcalcifications and malignancies. Microcalcification's texture features extracted in transform domains, have higher discriminating power to classify benign/malignant individual microcalcifications and samples compared to pure shape-features.
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Affiliation(s)
- Redona Brahimetaj
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel (VUB), Pleinlaan 2, Brussels, B-1050 Belgium
| | - Inneke Willekens
- Radiology Department, Universitair Ziekenhuis (UZ) Brussels, Laarbeeklaan 101, Brussels, 1090 Belgium
| | - Annelien Massart
- Radiology Department, Universitair Ziekenhuis (UZ) Brussels, Laarbeeklaan 101, Brussels, 1090 Belgium
| | - Ramses Forsyth
- Pathology Department, Universitair Ziekenhuis (UZ) Brussels, Laarbeeklaan 101, Brussels, 1090 Belgium
| | - Jan Cornelis
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel (VUB), Pleinlaan 2, Brussels, B-1050 Belgium
| | - Johan De Mey
- Radiology Department, Universitair Ziekenhuis (UZ) Brussels, Laarbeeklaan 101, Brussels, 1090 Belgium
| | - Bart Jansen
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel (VUB), Pleinlaan 2, Brussels, B-1050 Belgium
- IMEC, Kapeldreef 75, Leuven, B-3001 Belgium
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Webber C, Whitehead M, Eisen A, Holloway CMB, Groome PA. Breast cancer diagnosis and treatment wait times in specialized diagnostic units compared with usual care: a population-based study. Curr Oncol 2020; 27:e377-e385. [PMID: 32905256 PMCID: PMC7467790 DOI: 10.3747/co.27.6115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Breast assessment sites (bass) were developed to provide expedited and coordinated care for patients being evaluated for breast cancer (bca) in Ontario. We compared the diagnostic and treatment intervals for patients diagnosed at a bas and for those diagnosed through a usual care (uc) route. Methods This population-based, cross-sectional study of patients diagnosed with bca in Ontario during 2007-2015 used linked administrative data. "Diagnostic interval" was the time from the earliest cancer-related health care encounter before diagnosis to diagnosis; "treatment interval" was the time from diagnosis to treatment. Diagnosis at a bas was determined from the patient's biopsy and mammography institutions. Interval lengths for the bas and uc groups were compared using multivariable quantile regression, stratified by detection method. Results The diagnostic interval was shorter for patients who were bas-diagnosed than for those who were uc-diagnosed, with adjusted median differences of -4.0 days [95% confidence interval (ci): -3.2 days to -4.9 days] for symptomatic patients and -5.4 days (95% ci: -4.7 days to -6.1 days) for screen-detected patients. That association was modified by stage at diagnosis, with larger differences in patients with early-stage cancers. In contrast, the treatment interval was longer in patients who were bas-diagnosed than in those who were uc-diagnosed, with adjusted median differences of 4.2 days (95% ci: 3.8 days to 4.7 days) for symptomatic patients and 4.2 days (95% ci: 3.7 days to 4.8 days) for screen-detected patients. Conclusions Diagnosis of bca through a bas was associated with a shorter diagnostic interval, but a longer treatment interval. Although efficiencies in the diagnostic interval might help to reduce distress experienced by patients, the longer treatment intervals for patients who are bas-diagnosed remain a cause for concern.
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Affiliation(s)
- C Webber
- The Ottawa Hospital Research Institute and Bruyère Research Institute, Ottawa
| | | | - A Eisen
- Ontario Health (Cancer Care Ontario), Toronto
| | - C M B Holloway
- Ontario Health (Cancer Care Ontario), Toronto
- Department of Surgery, University of Toronto, Toronto
| | - P A Groome
- ices Queen's, Kingston
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, and Department of Public Health Sciences, Queen's University, Kingston, ON
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8
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Sweeny K, Christianson D, McNeill J. The Psychological Experience of Awaiting Breast Diagnosis. Ann Behav Med 2020; 53:630-641. [PMID: 30239562 DOI: 10.1093/abm/kay072] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Each year, over 1 million women in the USA undergo diagnostic breast biopsies, many of which culminate in a benign outcome. However, for many patients, the experience of awaiting biopsy results is far from benign, instead provoking high levels of distress. PURPOSE To take a multifaceted approach to understanding the psychological experience of patients undergoing a breast biopsy. METHOD Female patients (N = 214) were interviewed at an appointment for a breast biopsy, just prior to undergoing the biopsy procedure. Pertinent to the current investigation, the interview assessed various patient characteristics, subjective health and cancer history, support availability, outcome expectations, distress, and coping strategies. RESULTS The findings revealed a complex set of interrelationships among patient characteristics, markers of distress, and use of coping strategies. Patients who were more distressed engaged in more avoidant coping strategies. Regarding the correlates of distress and coping, subjective health was more strongly associated with distress and coping than was cancer history; perceptions of support availability were also reliably associated with distress. CONCLUSION Taken together, the results suggest that patients focus on their immediate experience (e.g., subjective health, feelings of risk, perceptions of support) in the face of the acute moment of uncertainty prompted by a biopsy procedure, relative to more distal considerations such as cancer history and demographic characteristics. These findings can guide clinicians' interactions with patients at the biopsy appointment and can serve as a foundation for interventions designed to reduce distress in this context.
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Affiliation(s)
- Kate Sweeny
- Department of Psychology, University of California, Riverside, Riverside, CA, USA
| | - Deborah Christianson
- Radiology Department, Riverside University Health System-Medical Center, Moreno Valley, CA, USA
| | - Jeanine McNeill
- Radiology Department, Riverside University Health System-Medical Center, Moreno Valley, CA, USA
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McGill N, McLeod S. Waiting list management in speech-language pathology: translating research to practice. SPEECH LANGUAGE AND HEARING 2020. [DOI: 10.1080/2050571x.2020.1716471] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Nicole McGill
- School of Teacher Education, Charles Sturt University, Bathurst, Australia
| | - Sharynne McLeod
- School of Teacher Education, Charles Sturt University, Bathurst, Australia
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Cantril C, Moore E, Yan X. Diagnosis Disclosure: Patient Preferences and the Role of the Breast Nurse Navigator. Clin J Oncol Nurs 2019; 23:619-626. [PMID: 31730594 DOI: 10.1188/19.cjon.619-626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Receiving a breast cancer diagnosis can be traumatic and anxiety-producing. The way the diagnosis is disclosed to patients can affect their experience. OBJECTIVES The aim of this article is to determine patient preferences for being informed of a breast cancer diagnosis and the breast nurse navigator (BNN) role during the diagnostic experience. METHODS A survey was mailed to 517 patients with breast cancer. Summary statistics were performed on 199 completed surveys. FINDINGS Patients preferred to hear their diagnosis in person. BNNs were more likely to provide the right amount of support and resources compared to other providers. Patients described the following preferences.
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Saraswathula A, Lee JY, Megwalu UC. Patient preferences regarding the communication of biopsy results in the general otolaryngology clinic. Am J Otolaryngol 2019; 40:83-88. [PMID: 30472134 DOI: 10.1016/j.amjoto.2018.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/06/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To determine the preferred methods of communicating biopsy results for patients in our comprehensive otolaryngology clinic, and to examine factors associated with preferring remote vs. in-person communication of results. STUDY DESIGN Cross-sectional study. SETTING Academic comprehensive otolaryngology clinic. SUBJECTS AND METHODS A survey instrument was administered to 107 consecutive adult otolaryngology patients undergoing head and neck fine needle aspiration biopsy from March 1, 2017 to April 30, 2018 assessing their health literacy using the Brief Health Literacy Score and their preferred method of notification of biopsy results (in-person vs. remote). RESULTS 69% of patients preferred remote notification of their biopsy results (either by telephone or via an online portal). 54% of patients prioritized clear explanation of the results as the most important factor when communicating a malignant result. Adequate health literacy was associated with lower odds of preferring in-person notification (adjusted odds ratio 0.11, 95% CI 0.03 to 0.39). Patients who prioritized clear explanation of the results were more likely to prefer in-person notification (adjusted OR 4.13, 95% CI 1.31 to 14.88). CONCLUSIONS A significant proportion of patients in our comprehensive otolaryngology clinic undergoing fine needle aspiration biopsy preferred remote communication of their biopsy results. Patients most valued clear explanations from the provider and prompt receipt of the result when communicating malignant results. This highlights the need for individualized results communication plans, for patients undergoing biopsy.
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El Hachem Z, Zoghbi M, Hallit S. Psychosocial consequences of false-positive results in screening mammography. J Family Med Prim Care 2019; 8:419-425. [PMID: 30984648 PMCID: PMC6436251 DOI: 10.4103/jfmpc.jfmpc_4_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: To evaluate the psychosocial impact of benign breast biopsies on Lebanese women after a screening mammography and the effect of these biopsies on patients’ attitudes toward subsequent screening. Methods: In this retrospective study (January 2005 till April 2011), 109 consecutive patients with a history of breast biopsy without cancer were asked to answer a phone questionnaire. The response rate was 91.7% (100 women accepted to participate). A questionnaire about sociodemographic characteristics, biopsy characteristics, and patients’ attitudes as measured by the negative Psychosocial Consequences Questionnaire (PCQ) and other independent questions was filled by phone call by one interviewer. Results: The negative PCQ score was low for most women (only 9% have a negative PCQ score ≥18/36) and is statistically dependent on the result of the last mammography (P = 0.01) and the number of previous benign breast biopsies (P = 0.01). A total of 10% of women increased their medical visits after this biopsy, 8% were treated for psychiatric problems after this biopsy, and 19% self-examine their breasts more than once per week. The benign breast biopsy experience increases the willingness to adhere to the screening mammography in 71% of the patients, this reported adherence depends positively on the score of the negative PCQ (P = 0.043). Conclusions: The negative psychosocial effect of the biopsy is minimal in general and is positively correlated to the adherence to future mammographies. Interventions are necessary to decrease the anxiety in most susceptible women and to raise the awareness of women at risk of nonadherence to the screening mammography.
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Affiliation(s)
- Zeina El Hachem
- Department of Internal Medicine, Hayek Hospital, Horsh Tabet, Sin el Fil, Beirut, Lebanon
| | - Marouan Zoghbi
- Department of Family Medicine, Universite Saint Joseph, Beirut.,Psychiatric Hospital of the Cross, Jounieh, Lebanon
| | - Souheil Hallit
- Department of Family Medicine, Universite Saint Joseph, Beirut.,Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh.,INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut.,Faculty of Medicine, Universite Saint-Esprit Kaslik, Kaslik, Lebanon
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13
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The Effect of Psychoeducation on Anxiety in Women Undergoing Their Initial Breast Cancer Screening Mammography. J Nerv Ment Dis 2018; 206:931-934. [PMID: 30439780 DOI: 10.1097/nmd.0000000000000904] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We conducted a prospective, randomized, single-blinded study to determine whether a psychoeducational intervention for patients undergoing screening mammography could influence the level of anxiety related to the procedure. Fifty women undergoing mammography for the first time were included in the study and randomized to two groups. In the study group, patients received a psychoeducational session before mammography. In the control group, psychoeducation was not applied. To evaluate the level of anxiety, we used the State-Trait Anxiety Inventory. State Anxiety Scale (S-Anxiety) score and Trait Anxiety Scale (T-Anxiety) scores were assessed before and after mammography in both groups. After evaluating the S-Anxiety score in the study group before mammography and after the procedure, a statistically significant difference (p = 0.043) was observed. In contrast, no statistically significant changes were noticed in the control group (p = 0.886). Our study showed that psychoeducation reduced state anxiety among the participants of a breast cancer screening.
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Karliner LS, Kaplan C, Livaudais-Toman J, Kerlikowske K. Mammography facilities serving vulnerable women have longer follow-up times. Health Serv Res 2018; 54 Suppl 1:226-233. [PMID: 30394526 PMCID: PMC6341204 DOI: 10.1111/1475-6773.13083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective To investigate mammography facilities’ follow‐up times, population vulnerability, system‐based processes, and association with cancer stage at diagnosis. Data Sources Prospectively collected from San Francisco Mammography Registry (SFMR) 2005‐2011, California Cancer Registry 2005‐2012, SFMR facility survey 2012. Study Design We examined time to biopsy for 17 750 abnormal mammogram results (BI‐RADS 4/5), categorizing eight facilities as short or long follow‐up based on proportion of mammograms with biopsy at 30 days. We examined facility population vulnerability (race/ethnicity, language, education), and system processes. Among women with a cancer diagnosis, we modeled odds of advanced‐stage (≥IIb) cancer diagnosis by facility follow‐up group. Data Extraction Methods Merged SFMR, Cancer Registry and facility survey data. Principal Findings Facilities (N = 4) with short follow‐up completed biopsies by 30 days for 82% of mammograms compared with 62% for facilities with long follow‐up (N = 4) (P < 0.0001). All facilities serving high proportions of vulnerable women were long follow‐up facilities. The long follow‐up facilities had fewer radiologists, longer biopsy appointment wait times, and less communication directly with women. Having the index abnormal mammogram at a long follow‐up facility was associated with higher adjusted odds of advanced‐stage cancer (OR 1.45; 95% CI 1.10‐1.91). Conclusions Providing mammography facilities serving vulnerable women with appropriate resources may decrease disparities in abnormal mammogram follow‐up and cancer diagnosis stage.
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Affiliation(s)
- Leah S Karliner
- Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, California.,Multiethnic Health Equity Research Center, University of California San Francisco, San Francisco, California
| | - Celia Kaplan
- Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, California.,Multiethnic Health Equity Research Center, University of California San Francisco, San Francisco, California
| | - Jennifer Livaudais-Toman
- Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, California.,Multiethnic Health Equity Research Center, University of California San Francisco, San Francisco, California
| | - Karla Kerlikowske
- General Internal Medicine Section, San Francisco Veteran Affairs Medical Center, San Francisco, California.,Departments of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
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15
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Bedell A, Taft T, Craven MR, Guadagnoli L, Hirano I, Gonsalves N. Impact on Health-Related Quality of Life in Adults with Eosinophilic Gastritis and Gastroenteritis: A Qualitative Assessment. Dig Dis Sci 2018; 63:1148-1157. [PMID: 29476289 PMCID: PMC6701628 DOI: 10.1007/s10620-018-4978-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/12/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Eosinophilic gastritis (EG) and eosinophilic gastroenteritis (EGE) are chronic immune-mediated conditions of the digestive tract, which affect the stomach only, or the stomach and small intestines, respectively. Though these disorders are uncommon, they are being increasingly recognized and diagnosed. While health-related quality of life (HRQOL) has been evaluated in other eosinophilic gastrointestinal diseases, this study is the first to describe HRQOL impacts unique to EG/EGE. AIMS This study aims to qualitatively describe experiences of adults diagnosed with EG and EGE. We aim to identify impacts on HRQOL in this population in order to inform clinical care and assessment. METHODS Seven patients diagnosed with EG or EGE participated in semi-structured interviews assessing common domains of HRQOL. RESULTS Four distinct themes emerged from qualitative analyses, which represent impacts to HRQOL: the psychological impact of the diagnosis, impact on social relationships, financial impact, and impact on the body. These generally improved over time and with effective treatment. CONCLUSIONS This study demonstrated that patients with EG/EGE experience impacts to HRQOL, some of which differ from HRQOL of other eosinophilic gastrointestinal diseases. These results support the development of a disease-specific measure, or adaptation of an existing measure, to assess HRQOL in EG/EGE.
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Affiliation(s)
- Alyse Bedell
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair St. #1400, Chicago, IL 60611, USA
| | - Tiffany Taft
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair St. #1400, Chicago, IL 60611, USA
| | - Meredith R. Craven
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair St. #1400, Chicago, IL 60611, USA
| | - Livia Guadagnoli
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair St. #1400, Chicago, IL 60611, USA
| | - Ikuo Hirano
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair St. #1400, Chicago, IL 60611, USA
| | - Nirmala Gonsalves
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair St. #1400, Chicago, IL 60611, USA
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Walker MS, Farria D, Schmidt M, Monsees B, Wiele K, Bokern J, Swatske ME. Educational Intervention for Women Undergoing Image-Guided Breast Biopsy: Results of a Randomized Clinical Trial. Cancer Control 2017; 14:380-7. [PMID: 17914338 DOI: 10.1177/107327480701400408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The process of informed consent has been examined for patients undergoing various procedures but not breast biopsy. Our study was a randomized trial that examined the effect of an educational flip chart as part of the informed consent. Methods A total of 122 patients referred for stereotactic or ultrasound-guided core breast biopsy were randomly assigned to receive an informed consent discussion with or without an illustrated flip chart. The chart included information about breast anatomy, pathology, and diagnostic procedures. Outcome measures included objective knowledge, subjective knowledge, anxiety, and satisfaction. Results Analysis showed few significant main effects of the intervention. However, results showed interactions between experimental condition and race/ethnicity, indicating that the intervention was effective in enhancing objective and subjective knowledge for African American but not Caucasian patients. Anxiety after consultation was higher among patients assigned to the flip chart condition, possibly because they were better informed about the risks of the procedure. Patients who underwent biopsy sooner after learning they needed one were more satisfied with their care. Conclusions The usual care consent process is effective for many but not all patients. Informed consent that employs visual aids may help overcome characteristics of the consent process that are ineffective for some patients.
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Affiliation(s)
- Mark S Walker
- Departments of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.
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17
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An evaluation of patient experience during percutaneous breast biopsy. Eur Radiol 2017; 27:4804-4811. [PMID: 28534164 DOI: 10.1007/s00330-017-4872-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 04/04/2017] [Accepted: 04/27/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Percutaneous breast biopsy in a tertiary referral high volume breast centre: can we improve the patient experience? PURPOSE The study was performed to evaluate patient experience during ultrasound-guided (UGB) and vacuum-assisted stereotactic breast biopsy (SBB) and determine what factors could improve the patient experience. METHODS Consecutive patients who underwent image guided breast biopsy from 01- 05/30, 2015 were approached in a structured telephone interview to evaluate pain and bruising from the procedure. Three hundred and fifty-one patients were interviewed (116 SBB and 235 UGB). Information about the radiologist performing the biopsy, biopsy type, needle gauge, and number of cores was collected from the biopsy reports. Correlation was done using Spearman rank test. RESULTS Average patient scores of pain with UGB and SBB were 2.3 and 3.1 (out of 10). There was a significant correlation between pain during SBB and physician experience (p = 0.013), and no correlation with pain during UGB (p > 0.05). No correlation was found between needle gauge and pain experienced during breast biopsy or between numbers of cores and pain (p > 0.05). Body position during SBB was mentioned to cause discomfort and pain in 28% of patients while during UGB was mentioned by 0.4% of patients. CONCLUSION SBB was inferior to UGB for patient experience, but years of radiologists' experience correlated with improved patient scores of pain for SBB. KEY POINTS • To achieve high quality, an institution must emphasise patient-centred care. • Increased radiologist training with stereotactic biopsy may contribute to improved patient experience. • Stereotactic breast biopsy was inferior to ultrasound biopsy for patient experience. • Radiologists' experience correlated with improved patient scores of pain for stereotactic biopsy.
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18
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Dooley MD, Burreal S, Sweeny K. "We'll call you when the results are in": Preferences for how medical test results are delivered. PATIENT EDUCATION AND COUNSELING 2017; 100:364-366. [PMID: 27503287 DOI: 10.1016/j.pec.2016.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 07/28/2016] [Accepted: 08/01/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Whether healthy or sick, adults undergo frequent medical testing; however, no guidelines currently exist as to how patients are informed of their medical test results. This short report provides an initial look at how healthcare professionals deliver medical test results and patient preferences regarding these procedures. METHODS We specifically focus on two options for delivery of results: (1) open-ended timing, in which patients are contacted without warning when test results become available; or (2) closed-ended timing, in which patients are provided with a specific day and time when they will learn their test results. Participants who underwent a recent medical test indicated which delivery method their healthcare professional provided and their preferred method. RESULTS Findings demonstrate a large discrepancy between actual and preferred timing, stemming from a general trend towards providing open-ended timing, whereas patient preferences were evenly split between the two options. CONCLUSION This study provides a first step in understanding the merits of two options for delivering medical test results to patients and suggests an opportunity to improve patient care. PRACTICE IMPLICATIONS The findings from this study provide first steps toward the development of guidelines for delivering test results in ways that maximize the quality of patient care.
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Affiliation(s)
- Michael D Dooley
- Department of Psychology, University of California, Riverside, Riverside, CA, USA
| | - Shay Burreal
- Department of Psychology, University of California, Riverside, Riverside, CA, USA
| | - Kate Sweeny
- Department of Psychology, University of California, Riverside, Riverside, CA, USA.
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19
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Perlman KL, Shelby RA, Wren AA, Kelleher SA, Dorfman CS, O'Connor E, Kim C, Johnson KS, Soo MS. Positive and negative mood following imaging-guided core needle breast biopsy and receipt of biopsy results. PSYCHOL HEALTH MED 2016; 22:1149-1162. [PMID: 28007008 DOI: 10.1080/13548506.2016.1271438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Positive and negative mood are independent psychological responses to stressful events. Negative mood negatively impacts well-being and co-occurring positive mood leads to improved adjustment. Women undergoing core needle breast biopsies (CNB) experience distress during CNB and awaiting results; however, influences of mood are not well known. This longitudinal study examines psychosocial and biopsy- and spirituality-related factors associated with mood in patients day of CNB and one week after receiving results. Ninety women undergoing CNB completed questionnaires on psychosocial factors (chronic stress, social support), biopsy experiences (pain, radiologist communication), and spirituality (peace, meaning, faith) day of CNB. Measures of positive and negative mood were completed day of CNB and one week after receiving results (benign n = 50; abnormal n = 25). Multiple linear regression analyses were conducted. Greater positive mood correlated with greater peace (β = .25, p = .02) day of CNB. Lower negative mood correlated with greater peace (β = -.29, p = .004) and there was a trend for a relationship with less pain during CNB (β = .19, p = .07). For patients with benign results, day of CNB positive mood predicted positive mood post-results (β = .31, p = .03) and only chronic stress predicted negative mood (β = .33, p = .03). For women with abnormal results, greater meaning day of CNB predicted lower negative mood post-results (β = -.45, p = .03). Meaning and peace may be important for women undergoing CNB and receiving abnormal results.
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Affiliation(s)
- Katherine L Perlman
- a Department of Psychiatry and Behavioral Sciences , Duke University Medical Center (DUMC) , Durham , NC , USA
| | - Rebecca A Shelby
- a Department of Psychiatry and Behavioral Sciences , Duke University Medical Center (DUMC) , Durham , NC , USA
| | - Anava A Wren
- a Department of Psychiatry and Behavioral Sciences , Duke University Medical Center (DUMC) , Durham , NC , USA
| | - Sarah A Kelleher
- a Department of Psychiatry and Behavioral Sciences , Duke University Medical Center (DUMC) , Durham , NC , USA
| | - Caroline S Dorfman
- a Department of Psychiatry and Behavioral Sciences , Duke University Medical Center (DUMC) , Durham , NC , USA
| | - Erin O'Connor
- a Department of Psychiatry and Behavioral Sciences , Duke University Medical Center (DUMC) , Durham , NC , USA
| | - Connie Kim
- b Department of Radiology, Breast Imaging Division , DUMC , Durham , NC , USA
| | - Karen S Johnson
- b Department of Radiology, Breast Imaging Division , DUMC , Durham , NC , USA
| | - Mary Scott Soo
- b Department of Radiology, Breast Imaging Division , DUMC , Durham , NC , USA
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20
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Howell JL, Sweeny K. Is waiting bad for subjective health? J Behav Med 2016; 39:652-64. [DOI: 10.1007/s10865-016-9729-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 02/26/2016] [Indexed: 10/22/2022]
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21
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Nayeri A, Prablek MA, Brinson PR, Weaver KD, Thompson RC, Chambless LB. Short-term postoperative surveillance imaging may be unnecessary in elderly patients with resected WHO Grade I meningiomas. J Clin Neurosci 2015; 26:101-4. [PMID: 26707713 DOI: 10.1016/j.jocn.2015.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 11/08/2015] [Indexed: 01/13/2023]
Abstract
The optimal timing and frequency of postoperative imaging surveillance after a meningioma resection are not well-established. The low recurrence rates and slow growth of World Health Organization (WHO) Grade I meningiomas in particular have raised doubts about the utility of postoperative imaging surveillance. We sought to analyze the cost and utility of asymptomatic surveillance imaging in elderly patients after the resection of a WHO Grade I meningioma. We conducted a retrospective cohort study on 45 patients who had a primary WHO Grade I meningioma resected at our institution between 2001-2013 at or above the age of 60 with a minimum of 2 years of follow-up. All postoperative clinic notes were reviewed alongside imaging results to verify that patients were asymptomatic during the surveillance period. MRI and CT scan costs (all $USD) were estimated at $599.61 and $334.31 respectively based on the Centers for Medicare and Medicaid national averages. During an average follow-up period of 4.5 years, the average number of total imaging studies performed per asymptomatic patient was 3.58 with an average total cost of $2086.30 per patient. Forty-two (93%) patients had no new abnormal findings on any of their imaging. Three (7%) patients demonstrated either a new meningioma or progressive growth of the postoperative residual tumor on imaging. No asymptomatic patient underwent a reoperation. Our data suggest that elderly patients with resected WHO Grade I meningiomas are at low risk for recurrence and may not need asymptomatic surveillance imaging for the first several postoperative years.
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Affiliation(s)
- Arash Nayeri
- Vanderbilt University School of Medicine, 201 Light Hall, Nashville, TN 37232, USA.
| | - Marc A Prablek
- Vanderbilt University School of Medicine, 201 Light Hall, Nashville, TN 37232, USA
| | - Philip R Brinson
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kyle D Weaver
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Reid C Thompson
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lola B Chambless
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
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Hayes Balmadrid MA, Shelby RA, Wren AA, Miller LS, Yoon SC, Baker JA, Wildermann LA, Soo MS. Anxiety prior to breast biopsy: Relationships with length of time from breast biopsy recommendation to biopsy procedure and psychosocial factors. J Health Psychol 2015; 22:561-571. [PMID: 26424811 DOI: 10.1177/1359105315607828] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study investigated how time from breast biopsy recommendation to biopsy procedure affected pre-biopsy anxiety ( N = 140 women), and whether the relationship between wait time and anxiety was affected by psychosocial factors (chronic life stress, traumatic events, social support). Analyses showed a significant interaction between wait time and chronic life stress. Increased time from biopsy recommendation was associated with greater anxiety in women with low levels of life stress. Women with high levels of life stress experienced increased anxiety regardless of wait time. These results suggest that women may benefit from shorter wait times and receiving strategies for managing anxiety.
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23
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Sweeny K, Falkenstein A. Is Waiting the Hardest Part? Comparing the Emotional Experiences of Awaiting and Receiving Bad News. PERSONALITY AND SOCIAL PSYCHOLOGY BULLETIN 2015; 41:1551-9. [DOI: 10.1177/0146167215601407] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 07/27/2015] [Indexed: 11/15/2022]
Abstract
Awaiting uncertain news is stressful, but is it more stressful than receiving bad news? We compared these emotional experiences in two studies. Participants in Study 1 reflected on a personal experience awaiting news that ultimately turned out badly, and participants in Study 2 were law graduates awaiting their results on the bar exam who ultimately failed the exam. In Study 1, participants were ambivalent as to whether awaiting or receiving bad news was more difficult, and emotion ratings in both studies confirmed this ambivalence. Anxiety was higher in anticipation of bad news (at least at the moment of truth) than in the face of it, whereas other negative emotions were more intense following the news than during the waiting period. Thus, whether waiting is “the hardest part” depends on whether one prefers to be racked with anxiety or afflicted with other negative emotions such as anger, disappointment, depression, and regret.
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Goldberg DR, Wardell DW, Kilgarriff N, Williams B, Eichler D, Thomlinson P. An Initial Study Using Healing Touch for Women Undergoing a Breast Biopsy. J Holist Nurs 2015; 34:123-34. [PMID: 25976090 DOI: 10.1177/0898010115585414] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM To determine if a noninvasive complementary therapy, Healing Touch, would benefit women undergoing diagnostic procedures for the determination of breast cancer. Women often experience high levels of fear and anxiety during this diagnostic period. STUDY DESIGN A randomized controlled pilot study. METHOD An out-patient clinic specializing in breast care management was used. Seventy-three women age 18 to 85 years old participated, with 31 in the control group of standard care and 42 in the intervention group receiving Healing Touch, a noninvasive energy therapy. A specific technique, magnetic clearing, was provided by a practitioner for 15 minutes prior to the biopsy procedure. Both the State-Trait Anxiety Inventory and the Coping Resources Inventory were used preprocedurally and the following day to assess changes. RESULTS A mixed analysis of variance indicated that State Anxiety for the Healing Touch group showed a statistically significant reduction of anxiety that was sustained into the following day, F(2, 142) = 10.94, p < .001. For Trait Anxiety, there was a significant change pre-and postintervention to the day after, F(2, 142) = 5.15, p < .007. The Coping Resources Inventory had significant changes in two subcategories, Emotional, F(2, 142) = 6.10, p = .003, and the Spiritual/Philosophical, F(2, 142) = 6.10, p < .001, in the Healing Touch group. CONCLUSION Healing Touch may have benefit in reducing anxiety from diagnostic breast procedures.
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25
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Morse JM, Pooler C, Vann-Ward T, Maddox LJ, Olausson JM, Roche-Dean M, Colorafi K, Madden C, Rogers B, Martz K. Awaiting diagnosis of breast cancer: strategies of enduring for preserving self. Oncol Nurs Forum 2015; 41:350-9. [PMID: 24969245 DOI: 10.1188/14.onf.350-359] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To explicate the emotional experiences of women undergoing breast cancer diagnosis who are waiting for the results of breast biopsy. RESEARCH APPROACH Glaserian Grounded Theory. SETTING Urban area in western Canada. PARTICIPANTS 37 women aged 32-76 years. The breast cancer diagnosis was positive for 11 women, negative for 24 women, and two results were unclear. METHODOLOGIC APPROACH Unstructured, recorded telephone interviews. FINDINGS Undergoing breast cancer diagnosis is a profoundly distressing experience dictated by diagnostic processes and procedures. Women rapidly transitioned from wellness to frightening phases of facing cancer to continuing terror during the testing phase. While waiting to hear results, women controlled their emotions, which enabled them to get through the experience and highlighted the protective function of enduring and its necessity for survival. The basic social psychological process, preserving self, is the outcome of enduring. CONCLUSIONS A mid-range theory, Awaiting Diagnosis: Enduring for Preserving Self, was developed. This theory explicates the emotional responses of women who were undergoing diagnosis for breast cancer and provides a theoretical behavioral basis for responding to cues and signals of suffering. INTERPRETATION The Praxis Theory of Suffering enables nurses to recognize and respond according to the behaviors of suffering, and to endure with healthy, adaptive, and normalizing behaviors that enable preserving self.
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Affiliation(s)
- Janice M Morse
- College of Nursing, University of Utah in Salt Lake City
| | - Charlotte Pooler
- Edmonton Zone of the Alberta Health Services and Faculty of Nursing, University of Alberta in Canada
| | | | - Lory J Maddox
- College of Nursing, University of Utah, Salt Lake City
| | | | | | - Karen Colorafi
- College of Nursing and Health Innovation, Arizona State University in Phoenix
| | | | | | - Kim Martz
- School of Nursing, Boise State University in Idaho
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26
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Nessim C, Winocour J, Holloway DPM, Saskin R, Holloway CMB. Wait times for breast cancer surgery: effect of magnetic resonance imaging and preoperative investigations on the diagnostic pathway. J Oncol Pract 2015; 11:e131-8. [PMID: 25670200 DOI: 10.1200/jop.2014.002105] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Women with breast cancer often require an extensive diagnostic work-up. We sought to determine the overall wait time, from the patient's perspective, from identification of an imaging abnormality to definitive treatment. The objective was to identify which factors contribute to overall wait time in women with breast cancer. METHODS A retrospective chart review in a tertiary care center was performed to identify all women who had breast surgery for invasive carcinoma and ductal carcinoma in situ. We recorded the dates of first imaging abnormality, first biopsy, subsequent imaging and biopsy, first consultation with any physician at the cancer center, first surgical consultation, and date of surgery. Clinical data that might influence these dates were then extracted. Wait times were calculated and factors associated with wait times were described. RESULTS Eligible consecutive women with a cancer diagnosis (n = 264) were identified. The median time between first imaging abnormality and definitive surgery was 79 days. The median time from first surgical consultation to surgery was significantly longer in women who underwent magnetic resonance imaging and in women who underwent initial imaging outside of our tertiary care center (P < .05). On multivariable analysis, the modifiable factors associated with prolonged wait times included number of preoperative clinic visits, number of visits to radiology, and initial imaging outside of our center (P < .05). CONCLUSION Extensive diagnostic work-up is an important factor that affects the time to definitive surgery. A more integrated approach using a rapid diagnostic clinic for tissue diagnosis initially, followed by facilitated preoperative evaluation, may potentially decrease wait times in breast evaluation.
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Affiliation(s)
- Carolyn Nessim
- Odette Cancer Centre and Sunnybrook Health Sciences Centre; University of Toronto; and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Julian Winocour
- Odette Cancer Centre and Sunnybrook Health Sciences Centre; University of Toronto; and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Diana P M Holloway
- Odette Cancer Centre and Sunnybrook Health Sciences Centre; University of Toronto; and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Refik Saskin
- Odette Cancer Centre and Sunnybrook Health Sciences Centre; University of Toronto; and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Claire M B Holloway
- Odette Cancer Centre and Sunnybrook Health Sciences Centre; University of Toronto; and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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Women's experiences of the breast cancer diagnostic process: A thematic evaluation of the literature; Recall & biopsy. Radiography (Lond) 2015. [DOI: 10.1016/j.radi.2014.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Schonberg MA, Silliman RA, Ngo LH, Birdwell RL, Fein-Zachary V, Donato J, Marcantonio ER. Older women's experience with a benign breast biopsy—a mixed methods study. J Gen Intern Med 2014; 29:1631-40. [PMID: 25138983 PMCID: PMC4242866 DOI: 10.1007/s11606-014-2981-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 06/30/2014] [Accepted: 07/15/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Little is known about older women's experience with a benign breast biopsy. OBJECTIVES To examine the psychological impact and experience of women ≥ 65 years of age with a benign breast biopsy. DESIGN Prospective cohort study using quantitative and qualitative methods. SETTING Three Boston-based breast imaging centers. PARTICIPANTS Ninety-four English-speaking women ≥ 65 years without dementia referred for breast biopsy as a result of an abnormal mammogram, not aware of their biopsy results at baseline, and with a subsequent negative biopsy. MEASUREMENTS We interviewed women at the time of breast biopsy (before women knew their results) and 6 months post-biopsy. At both interviews, participants completed the validated negative psychological consequences of screening mammography questionnaire (PCQ, scores range from 0 to 36 [high distress], PCQ ≥ 1 suggests a psychological consequence, PCQs <1 are reported at time of screening) and women responded to open-ended questions about their experience. At follow-up, participants described the quality of information received after their benign breast biopsy. We used a linear mixed effects model to examine if PCQs declined over time. We also reviewed participants' open-ended comments for themes. RESULTS Overall, 88% (83/94) of participants were non-Hispanic white and 33% (31/94) had a high-school degree or less. At biopsy, 76% (71/94) reported negative psychological consequences from their biopsy compared to 39% (37/94) at follow-up (p < 0.01). In open-ended comments, participants noted the anxiety (29%, 27/94) and discomfort (28%, 26/94) experienced at biopsy (especially from positioning on the biopsy table). Participants requested more information to prepare for a biopsy and to interpret their negative results. Forty-four percent (39/89) reported at least a little anxiety about future mammograms. CONCLUSIONS The high psychological burden of a benign breast biopsy among older women significantly diminishes with time but does not completely resolve. To reduce this burden, older women need more information about undergoing a breast biopsy.
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Affiliation(s)
- Mara A. Schonberg
- />Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA USA
| | - Rebecca A. Silliman
- />Geriatrics Section, Boston University Schools of Medicine and Public Health, Boston University Medical Center, Boston, MA USA
| | - Long H. Ngo
- />Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA USA
| | - Robyn L. Birdwell
- />Breast Imaging, Department of Radiology, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA USA
| | - Valerie Fein-Zachary
- />Department of Radiology, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215 USA
| | - Jessica Donato
- />Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA USA
| | - Edward R. Marcantonio
- />Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA USA
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Hirschberg AM, Chan-Smutko G, Pirl WF. Psychiatric implications of cancer genetic testing. Cancer 2014; 121:341-60. [PMID: 25234846 DOI: 10.1002/cncr.28879] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 04/17/2014] [Accepted: 04/24/2014] [Indexed: 12/21/2022]
Abstract
As genetic testing for hereditary cancer syndromes has transitioned from research to clinical settings, research regarding its accompanying psychosocial effects has grown. Men and women being tested for hereditary cancer syndromes may experience some psychological distress while going through the process of testing or after carrier status is identified. Psychological distress appears to decrease over the course of the first year and it is typically not clinically significant. Longer term studies show mixed results with some mutation carriers continuing to experience elevated distress. Baseline distress is the greatest risk factor for both immediate (weeks-12 months) and long-term psychological distress (18 mo-8 years post genetic testing). In addition to baseline psychological distress, other risk factors can be identified to help identify individuals who may need psychosocial interventions during the genetic testing process. The challenges of providing clinical care to the growing population of individuals identified to be at increased risk for heritable cancers present opportunities for research and new models of care.
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Obadina ET, Dubenske LL, McDowell HE, Atwood AK, Mayer DK, Woods RW, Gustafson DH, Burnside ES. Online support: Impact on anxiety in women who experience an abnormal screening mammogram. Breast 2014; 23:743-8. [PMID: 25193424 DOI: 10.1016/j.breast.2014.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 06/25/2014] [Accepted: 08/05/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To determine whether an online support tool can impact anxiety in women experiencing an abnormal mammogram. MATERIALS AND METHODS We developed an online support system using the Comprehensive Health Enhancement Support System (CHESS) designed for women experiencing an abnormal mammogram as a model. Our trial randomized 130 of these women to online support (the intervention group) or to a list of five commonly used Internet sites (the comparison group). Surveys assessed anxiety and breast cancer worry, and patient satisfaction at three important clinical time points: when women were notified of their abnormal mammogram, at the time of diagnostic imaging, and at the time of biopsy (if biopsy was recommended). RESULTS Study participants in the intervention group showed a significant decrease in anxiety at the time of biopsy compared to the comparison group (p = 0.017). However, there was no significant difference in anxiety between the intervention group and the comparison group at the time of diagnostic work-up. We discontinued assessment of patient satisfaction after finding that many women had substantial difficulty answering the questions that referenced their physician, because they did not understand who their physician was for this process of care. CONCLUSION The combination of the inability to identify the physician providing care during the mammography work-up and anxiety effects seen only after an interaction with the breast imaging team may indicate that online support only decreases the anxiety of women in concert with direct interpersonal support from the healthcare team.
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Affiliation(s)
- Eniola T Obadina
- Department of Radiology, Johns Hopkins University, Baltimore, MD, United States
| | - Lori L Dubenske
- Center for Health Enhancement System Studies (CHESS), United States
| | | | - Amy K Atwood
- Center for Health Enhancement System Studies (CHESS), United States
| | - Deborah K Mayer
- School of Nursing, University of North Carolina, Chapel Hill, NC, United States
| | - Ryan W Woods
- Department of Radiology, University of Wisconsin, Madison, WI, United States
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Miller SJ, Sohl SJ, Schnur JB, Margolies L, Bolno J, Szabo J, Hermann G, Montgomery GH. Pre-biopsy psychological factors predict patient biopsy experience. Int J Behav Med 2014; 21:144-8. [PMID: 23065421 DOI: 10.1007/s12529-012-9274-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Excisional/surgical breast biopsy has been related to anticipatory emotional distress, and anticipatory distress has been associated with worse biopsy-related outcomes (e.g., pain, physical discomfort). PURPOSE The present study was designed to investigate (a) whether anticipatory distress before an image-guided breast biopsy would correlate with biopsy-related outcomes (pain and physical discomfort during the biopsy) and (b) whether type of distress (i.e., general anxiety, worry about the procedure, worry about biopsy results) would differentially relate to biopsy-related outcomes. METHODS Fifty image-guided breast biopsy patients (mean age = 44.4 years) were administered questionnaires pre- and post-biopsy. Pre-biopsy, patients completed the Profile of Mood States-tension/anxiety subscale and two visual analog scale items (worry about the biopsy procedure, worry about the biopsy results). Post-biopsy, patients completed two visual analog scale items (pain and physical discomfort at their worst during the procedure). RESULTS The following results were gathered: (1) Pre-biopsy worry about the procedure was significantly related to both pain (r = 0.38, p = 0.006) and physical discomfort (r = 0.31, p = 0.026); (2) pre-biopsy general anxiety was significantly related to pain (r = 0.36, p = 0.009), but not to physical discomfort; and (3) Pre-biopsy worry about the biopsy results did not significantly relate to pain or physical discomfort. CONCLUSIONS Worry about the procedure was the only variable found to be significantly correlated with both biopsy-related outcomes (pain and physical discomfort). From a clinical perspective, this item could be used as a brief screening tool to identify patients who might be at risk for poorer biopsy experiences and who might benefit from brief interventions to reduce pre-biopsy worry.
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Harding MM. Incidence of distress and associated factors in women undergoing breast diagnostic evaluation. West J Nurs Res 2013; 36:475-94. [PMID: 24107782 DOI: 10.1177/0193945913506795] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to identify the incidence of distress and factors associated with distress in women undergoing breast diagnostic evaluations. A total of 128 women undergoing a breast biopsy at three hospitals completed a set of nine standardized instruments. The presence of distress was identified with 14% having symptoms above the cutoff point for clinical anxiety. In multiple regression analyses, trait anxiety alone explained 71% of the State-Trait Anxiety Inventory State score. A model with trait anxiety, satisfaction with health care, meaning in life, and friend support accounted for 66% of the Hospital Anxiety and Depression Scale score for depression. It appears that when faced with a potential cancer diagnosis, distress levels are based on personality and self-evaluation of whether one has the resources to adapt to life with cancer. Distress screening protocols need to be routinely included in diagnostic radiology appointments. Nurses should implement interventions focusing on providing information, facilitating communication, and offering psychosocial support.
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Iwatani T, Matsuda A, Kawabata H, Miura D, Matsushima E. Predictive factors for psychological distress related to diagnosis of breast cancer. Psychooncology 2013; 22:523-9. [PMID: 23577351 DOI: 10.1002/pon.3023] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The aims of the present study were as follows: (i) to clarify the proportion of women who experience psychological distress during breast cancer diagnosis and (ii) to identify the predictors of psychological distress related to the diagnostic process. METHODS This was a longitudinal prospective study of women who required further breast examination. Questionnaires were administered at pre-medical consultations (Time 1), after describing radiological examination (Time 2), and after explaining pathological findings (Time 3). All participants completed Hospital Anxiety and Depression Scale (HADS), Functional Assessment of Cancer Therapy--Breast, and Functional Assessment of Chronic Illness Therapy--Spiritual subscale at Time 1 to identify predictors. Participants also completed HADS at Times 2 and 3 to identify the presence or absence of psychological distress. RESULTS Of the 222 eligible patients, at Time 2, 31 (22.6%) participants with no clinical abnormalities and 39 (45.9%) participants with abnormal findings had HADS scores of ≥ 11 points (χ2 test, 13.14; p < 0.001). At Time 3, 14 (28.0%) participants with benign breast changes and 24 (68.6%) participants with breast cancer had scores of ≥ 11 (χ2 test, 13.71; p < 0.001). Higher HADS scores at Time 1 were associated with the presence of psychological distress at all stages of breast cancer diagnosis. Advanced tumor stage was a predictor of psychological distress for participants with breast cancer (odds ratios = 3.314, 95% confidence interval = 1.033-9.509; p = 0.044). CONCLUSION These results suggest that intensive psychological intervention is necessary for breast cancer patients with large tumors, as well as for women with suspected breast cancer with high HADS scores at pre-consultation.
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Affiliation(s)
- Tsuguo Iwatani
- Section Division of Liaison Psychiatry and Palliative Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
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Körner A, Drapeau M, Thombs BD, Rosberger Z, Wang B, Khanna M, Spatz A, Coroiu A, Garland R, Batist G. Barriers and facilitators of adherence to medical advice on skin self-examination during melanoma follow-up care. BMC DERMATOLOGY 2013; 13:3. [PMID: 23448249 PMCID: PMC3600035 DOI: 10.1186/1471-5945-13-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 02/18/2013] [Indexed: 01/04/2023]
Abstract
BACKGROUND Melanoma is the fastest growing tumor of the skin, which disproportionately affects younger and middle-aged adults. As melanomas are visible, recognizable, and highly curable while in early stages, early diagnosis is one of the most effective measures to decrease melanoma-related mortality. Skin self-examination results in earlier detection and removal of the melanoma. Due to the elevated risk of survivors for developing subsequent melanomas, monthly self-exams are strongly recommended as part of follow-up care. Yet, only a minority of high-risk individuals practices systematic and regular self-exams. This can be improved through patient education. However, dermatological education is effective only in about 50% of the cases and little is known about those who do not respond. In the current literature, psychosocial variables like distress, coping with cancer, as well as partner and physician support are widely neglected in relation to the practice of skin self-examination, despite the fact that they have been shown to be essential for other health behaviors and for adherence to medical advice. Moreover, the current body of knowledge is compromised by the inconsistent conceptualization of SSE. The main objective of the current project is to examine psychosocial predictors of skin self-examination using on a rigorous and clinically sound methodology. METHODS/DESIGN The longitudinal, mixed-method study examines key psychosocial variables related to the acquisition and to the long-term maintenance of skin self-examination in 200 patients with melanoma. Practice of self-exam behaviors is assessed at 3 and 12 months after receiving an educational intervention designed based on best-practice standards. Examined predictors of skin self-exam behaviors include biological sex, perceived self-exam efficacy, distress, partner and physician support, and coping strategies. Qualitative analyses of semi-structured interviews will complement and enlighten the quantitative findings. DISCUSSION The identification of short and long-term predictors of skin self-examination and an increased understanding of barriers will allow health care professionals to better address patient difficulties in adhering to this life-saving health behavior. Furthermore, the findings will enable the development and evaluation of evidence-based, comprehensive intervention strategies. Ultimately, these findings could impact a wide range of outreach programs and secondary prevention initiatives for other populations with increased melanoma risk.
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Affiliation(s)
- Annett Körner
- Department of Educational and Counselling Psychology, McGill University, 3700, rue McTavish, Montréal, QC, H3A 1Y2, Canada
| | - Martin Drapeau
- Department of Educational and Counselling Psychology, McGill University, 3700, rue McTavish, Montréal, QC, H3A 1Y2, Canada
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333, Chemin de la Côte-Ste-Catherine, Montréal, QC, H3T 1E4, Canada
| | - Zeev Rosberger
- Louise-Granofsky-Psychosocial Oncology Program, Jewish General Hospital, 4333, Chemin de la Côte-Ste-Catherine, Montréal, QC, H3T 1E4, Canada
| | - Beatrice Wang
- Melanoma Clinic, Royal Victoria Hospital, MGill University Health Centre, 687 Pine Avenue West, Montréal, QC, H3A 1A1, Canada
| | - Manish Khanna
- Department of Dermatology, Jewish General Hospital, 3755, Chemin de la Côte-Ste-Catherine, Montréal, QC, H3S 1X2, Canada
| | - Alan Spatz
- Department of Pathology, Jewish General Hospital, 3755, Chemin de la Côte-Ste-Catherine, Montréal, QC, H3S 1X2, Canada
| | - Adina Coroiu
- Department of Educational and Counselling Psychology, McGill University, 3700, rue McTavish, Montréal, QC, H3A 1Y2, Canada
| | - Rosalind Garland
- Department of Educational and Counselling Psychology, McGill University, 3700, rue McTavish, Montréal, QC, H3A 1Y2, Canada
| | - Gerald Batist
- Segal Cancer Centre, Jewish General Hospital, 3755, Chemin de la Côte-Ste-Catherine, Montréal, QC, H3S 1X2, Canada
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Doré C, Gallagher F, Saintonge L, Hébert M. Breast cancer screening program: experiences of Canadian women and their unmet needs. Health Care Women Int 2013; 34:34-49. [PMID: 23216095 DOI: 10.1080/07399332.2012.673656] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this study was to describe the experiences of women waiting for results from the Québec Breast Cancer Screening Program and their need for support. A qualitative analysis of the interviews generated a description of (a) the experiences and emotions of women waiting for mammogram results and (b) the need for services and psychosocial support that were and were not met. The results revealed a "timeline" of the waiting process experienced by the women, and their unmet informational and psychosocial needs (such as a lack of information about the prediagnosis steps, lack of a resource person, and others).
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Affiliation(s)
- Chantal Doré
- School of Nursing Science, Faculty of Medicine, Sherbrooke University, Sherbrooke, Québec, Canada.
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Harding MM, McCrone S. Experiences of non-navigated women undergoing breast diagnostic evaluation. Clin J Oncol Nurs 2013; 17:E8-E12. [PMID: 23372108 DOI: 10.1188/13.cjon.e8-e12] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
During the diagnostic period, women need appropriate, timely information regarding tests and procedures. Nurse navigator programs were developed to combat the negative effects on survival that are caused by delays in the diagnosis of breast cancer and lack of support from the healthcare team. Nurse navigators decreased barriers to care, increased patient satisfaction, and lowered anxiety in women undergoing diagnostic evaluation. However, although patient navigation programs have become a presence in oncology centers, those programs and the accompanying support are not offered at every facility that provides components of diagnostic evaluation. Therefore, the purpose of the current study was to explore the experiences of women who underwent a breast diagnostic evaluation without any accompanying navigation services.
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Affiliation(s)
- Mariann M Harding
- Department of Nursing, Kent State University at Tuscarawas, New Philadelphia, OH, USA.
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Abstract
BACKGROUND Breast cancer is frequently diagnosed after an abnormal mammography result. Language barriers can complicate communication of those results. OBJECTIVES We evaluated the association of non-English language with delay in follow-up. METHODS Retrospective cohort study of women at 3 mammography facilities participating in the San Francisco Mammography Registry with an abnormal mammogram result from 1997 to 2008. We measured median time from report of abnormal result to first follow-up test. RESULTS Of 13,014 women with 16,109 abnormal mammograms, 4027 (31%) had a non-English patient language. Clinical facilities differed in proportion of non-English speakers and in time to first follow-up test: facility A (38%; 25 d), facility B (18%; 14 d), and facility C (51%; 41 d). Most mammography examinations (67%) had breast imaging and reporting data system 0 (incomplete) assessment, requiring radiographic follow-up. At 30 days of follow-up, 67% of all English speakers with incomplete assessments had a follow-up examination compared with 50% of all non-English speakers (P<0.0001). The facility with the least delay and the lowest proportion of non-English speakers, had the biggest difference by language; compared with English speakers and adjusting for education, non-English speakers had twice the odds ratio of >30-day delay in follow-up (odds ratio=2.3; 95% confidence interval, 1.4-3.9). CONCLUSIONS There are considerable differences among facilities in delays in diagnostic follow-up of abnormal mammography results. More attention must be paid to understanding mammography facility factors, such as wait time to schedule diagnostic mammography and radiology workload, to improve rates of timely follow-up, particularly for those facilities disproportionately serving vulnerable non-English speaking patients.
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Solbjør M, Forsmo S, Skolbekken JA, Sætnan AR. Experiences of Recall After Mammography Screening—A Qualitative Study. Health Care Women Int 2011; 32:1009-27. [DOI: 10.1080/07399332.2011.565530] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Tilburt JC, James KM, Sinicrope PS, Eton DT, Costello BA, Carey J, Lane MA, Ehlers SL, Erwin PJ, Nowakowski KE, Murad MH. Factors influencing cancer risk perception in high risk populations: a systematic review. Hered Cancer Clin Pract 2011; 9:2. [PMID: 21595959 PMCID: PMC3118965 DOI: 10.1186/1897-4287-9-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Accepted: 05/19/2011] [Indexed: 12/14/2022] Open
Abstract
Background Patients at higher than average risk of heritable cancer may process risk information differently than the general population. However, little is known about clinical, demographic, or psychosocial predictors that may impact risk perception in these groups. The objective of this study was to characterize factors associated with perceived risk of developing cancer in groups at high risk for cancer based on genetics or family history. Methods We searched Ovid MEDLINE, Ovid Embase, Ovid PsycInfo, and Scopus from inception through April 2009 for English-language, original investigations in humans using core concepts of "risk" and "cancer." We abstracted key information and then further restricted articles dealing with perceived risk of developing cancer due to inherited risk. Results Of 1028 titles identified, 53 articles met our criteria. Most (92%) used an observational design and focused on women (70%) with a family history of or contemplating genetic testing for breast cancer. Of the 53 studies, 36 focused on patients who had not had genetic testing for cancer risk, 17 included studies of patients who had undergone genetic testing for cancer risk. Family history of cancer, previous prophylactic tests and treatments, and younger age were associated with cancer risk perception. In addition, beliefs about the preventability and severity of cancer, personality factors such as "monitoring" personality, the ability to process numerical information, as well as distress/worry also were associated with cancer risk perception. Few studies addressed non-breast cancer or risk perception in specific demographic groups (e.g. elderly or minority groups) and few employed theory-driven analytic strategies to decipher interrelationships of factors. Conclusions Several factors influence cancer risk perception in patients at elevated risk for cancer. The science of characterizing and improving risk perception in cancer for high risk groups, although evolving, is still relatively undeveloped in several key topic areas including cancers other than breast and in specific populations. Future rigorous risk perception research using experimental designs and focused on cancers other than breast would advance the field.
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Affiliation(s)
- Jon C Tilburt
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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Steffens RF, Wright HR, Hester MY, Andrykowski MA. Clinical, demographic, and situational factors linked to distress associated with benign breast biopsy. J Psychosoc Oncol 2011; 29:35-50. [PMID: 21240724 DOI: 10.1080/07347332.2011.534024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Benign breast biopsy (BBB) can be distressing for many women. Few studies have examined specific aspects of the BBB more or less distressing or risk factors for distress. Women (N = 51) who had a recent BBB reported the magnitude of distress associated with specific aspects of their experience. Clinical and demographic variables were also examined as risk factors for distress. All women reported some distress associated with the BBB with one third reporting their experience was "very stressful." Generally, biopsy-specific events were more distressing than follow-up mammography. Distress risk factors included younger age, less education, nonsurgical biopsy, and no family history of breast cancer. Clinical efforts to better manage biopsy-related distress are warranted. The authors identified clinical and demographic risk factors that furnish a simple, efficient, and potentially cost-effective means of stratifying risk for distress in the breast biopsy setting.
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Affiliation(s)
- Rachel F Steffens
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY 40536-0086, USA.
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Montgomery M, McCrone SH. Psychological distress associated with the diagnostic phase for suspected breast cancer: systematic review. J Adv Nurs 2010; 66:2372-90. [DOI: 10.1111/j.1365-2648.2010.05439.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Boivin J, Lancastle D. Medical waiting periods: imminence, emotions and coping. ACTA ACUST UNITED AC 2010; 6:59-69. [PMID: 20088730 DOI: 10.2217/whe.09.79] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The diagnosis and treatment of various medical conditions requires patients to wait for results that are potentially threatening to their wellbeing (e.g., breast biopsy results, pregnancy test results after fertility treatment and genetic screening outcomes). Little research has been carried out to document the psychological processes that unfold during such waiting periods. The aim of the present study was to document the course of anxiety, depression, positive affect and coping during the waiting period before a pregnancy test result in fertility treatment. Using a daily record-keeping chart designed for fertility treatment, 61 women undergoing IVF were monitored daily for emotional reactions (e.g., anxiety, depression and positive affect) and coping during 7 days of active treatment (stimulation), 7 days of waiting to find out whether a pregnancy was achieved (waiting) and 4 days of reacting to the pregnancy test results (outcome). The stimulation stage of treatment was characterized by positive affect with a lesser degree of anxiety, whereas the predominant emotions in the waiting stage were a combination of positive affect and anxiety symptoms versus depression. From the pregnancy test day onwards, the predominant emotion was depression. There was a significant increase in coping activity between the stimulation and waiting stages, with variable effects across coping strategies. It was concluded that whilst medical waiting periods have a clearly defined emotional trajectory, the coping pattern is less differentiated. This may explain why waiting for medical test results is so demanding. Healthcare professionals can assist their patients by facilitating coping strategies that better fit the demands of the waiting period and by offering support once outcomes are known.
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Affiliation(s)
- Jacky Boivin
- Cardiff Fertility Studies Research Group, School of Psychology, Cardiff University, Tower Building, Park Place, Cardiff, CF10 3AT, Wales, UK.
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Montgomery M. Uncertainty During Breast Diagnostic Evaluation: State of the Science. Oncol Nurs Forum 2009; 37:77-83. [DOI: 10.1188/10.onf.77-83] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Al-Azri M, Al-Awisi H, Al-Moundhri M. Coping with a diagnosis of breast cancer-literature review and implications for developing countries. Breast J 2009; 15:615-22. [PMID: 19686231 DOI: 10.1111/j.1524-4741.2009.00812.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Breast cancer is the most common cancer affecting women worldwide. Women are at an increased risk of developing both physical and psychological morbidity after diagnosis; however, many use different strategies to cope with the disease. The aim of this article is to review the available literature on the impact of breast cancer diagnoses and the strategies used by women to cope with this disease. The implications of these emerging findings are extrapolated within the context of health services provided in developing countries. Electronic databases were used to search the relevant literature. The findings showed that women who were diagnosed with breast cancer are at risk of developing several psychological morbidities such as depression, anxiety, fatigue, negative thoughts, suicidal thoughts, fear of dying, sense of aloneness, sexual and body images problems, as well as an overall decrease in the quality of life. Several strategies are used by women with breast cancer to cope with the disease, including positive cognitive restructuring, wishful thinking, emotional expression, disease acceptance, increased religious practice, family and social support, and yoga and exercise. Breast cancer diagnoses have been associated with several devastating psychological consequences; however, many women have used different coping strategies to adjust their lives accordingly. Healthcare professionals in developing countries, who work with women with breast cancer, should be aware of the different coping mechanisms that women use when diagnosed with cancer. Integrating a coping strategy into the treatment regimen would constitute an important milestone in the palliative care of patients with breast cancer.
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Affiliation(s)
- Mohammed Al-Azri
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman.
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Abstract
The purpose of this study is to provide a critical review and synthesis of theoretical and research literature documenting the impact of avoidance on healthcare behaviors, identify the factors that influence healthcare avoidance and delay in the adult population, and propose a direction for future research. The Theory of Reasoned Action, Theory of Planned Behavior, Theory of Care-Seeking Behavior, the Transtheoretical Model, and the Behavioral Model of Health Services Use/Utilization are utilized to elaborate on the context within which individual intention to engage in healthcare behaviors occurs. Research literature on the concept of healthcare avoidance obtained by using computerized searches of CINAHL, MEDLINE, PSYCH INFO, and HAPI databases, from 1995 to 2007, were reviewed. Studies were organized by professional disciplines. Healthcare avoidance is a common and highly variable experience. Multiple administrative, demographic, personal, and provider factors are related to healthcare avoidance, for example, distrust of providers and/or the science community, health beliefs, insurance status, or socioeconomic/income level. Although the concept is recognized by multiple disciplines, limited research studies address its impact on healthcare decision making. More systematic research is needed to determine correlates of healthcare avoidance. Such studies will help investigators identify patients at risk for avoidant behaviors and provide the basis for health-promoting interventions. Methodological challenges include identification of characteristics of individuals and environments that hinder healthcare behaviors, as well as, the complexity of measuring healthcare avoidance. Studies need to systematically explore the influence of avoidance behaviors on specific healthcare populations at risk.
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Giske T, Artinian B. Patterns of 'balancing between hope and despair' in the diagnostic phase: a grounded theory study of patients on a gastroenterology ward. J Adv Nurs 2008; 62:22-31. [PMID: 18352961 PMCID: PMC2440414 DOI: 10.1111/j.1365-2648.2007.04523.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM The aim of the study was to learn how patients going through the diagnostic phase experienced and handled their situation. BACKGROUND Many studies report about the stressful diagnostic phase; however, none has presented a conceptual theory where the concepts are sufficiently related to each other. The Theory of Preparative Waiting has previously been published as a descriptive grounded theory and describes the experience of a group of gastroenterology patients going through the diagnostic phase. METHOD A classical grounded theory design was used, with data derived from 18 in-depth interviews with 15 patients in a gastroenterology ward at a Norwegian University Hospital. Interviews were conducted during 2002-2003. FINDINGS Participants' main concern was found to be how they could prepare themselves for the concluding interview and life after diagnosis. The theoretical code of 'balancing' had four patterns; controlling pain, rational awaiting, denial, and accepting. These patterns of 'balancing' guided how participants used the categories of 'Preparative Waiting Theory''seeking and giving information', 'interpreting clues', 'handling existential threats' and 'seeking respite'. Patterns were strategies, so one person could use more than one pattern. CONCLUSION The diagnostic phase was a difficult time for the participants and the 'Preparative Waiting Theory' can assist nurses in assessing how patients prepare themselves differently for getting a diagnosis. All patients would find it helpful to be followed up by a designated contact person at the ward; however, patients using mostly the patterns of controlling pain and denial would benefit most from such support.
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Affiliation(s)
- Tove Giske
- Bergen Deaconess University College and Haukeland University Hospital, Bergen, Norway.
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Lancastle D, Boivin J. A feasibility study of a brief coping intervention (PRCI) for the waiting period before a pregnancy test during fertility treatment. Hum Reprod 2008; 23:2299-307. [PMID: 18628259 DOI: 10.1093/humrep/den257] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Waiting for a pregnancy test during fertility treatment can be particularly stressful because distress and intrusive cognitions about the nature and implications of the result can reduce quality of life. The aim of this feasibility study was to establish whether a novel brief coping intervention (positive reappraisal coping intervention, PRCI) card that encouraged women waiting for an IVF pregnancy test to redefine the waiting period more positively would be acceptable and practical in this context. METHODS Women (n = 55) were randomly assigned on the day of embryo transfer. Women read either 10 statements in a PRCI (n = 28) or 10 statements in a positive self-affirmative (positive mood) intervention (PMI; n = 27) twice daily for 14 days between embryo transfer (T1) and the pregnancy test (T2). At T2, we evaluated the practicality, acceptability, perceived benefits and endorsements of these cards. RESULTS Compared with the PMI, the PRCI was rated as more helpful and suitable for the situation, helping women to feel more positive and better helping to sustain efforts to cope. There were no differences relating to the practicality of the intervention method. CONCLUSIONS PRCI was feasible in the IVF context and was perceived as an acceptable intervention to help minimize the strain of waiting for pregnancy test results during fertility treatment. Future research needs to evaluate the full benefits of PRCI against routine care during the waiting period.
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Affiliation(s)
- Deborah Lancastle
- Institute of Medical Genetics, School of Medicine, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, UK
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Abstract
AIM This paper is a report of an analysis of the concept of waiting for health care from the client's perspective. BACKGROUND Waiting is commonplace in many areas of health care and has become a topical and politically important issue in the provision of healthcare services. Whilst managers and governments search for solutions to this problem, it is important that this aspect of clients' healthcare experience is examined to evaluate its impact and implications for nursing practice. METHODS The PubMed and CINAHL databases (dating from 1950 and 1982 to 2007 respectively) were searched using the keywords 'health care' and 'waiting'. The reference lists of papers identified were also checked and this revealed literature from a number of other disciplines related to the concept. RESULTS Waiting for health care is identified as an unspecified yet measurable period of time between identification of a healthcare problem and its diagnosis and treatment, when clients experience uncertainty and powerlessness whilst anticipating a disease outcome. The critical attributes of waiting for health care are: a period of measured time, subjective interpretation of the perceived significance of the measured time, feeling uncertain and powerless and anticipation of a response to the healthcare need. CONCLUSION Strategies that facilitate contact with clients through pre-assessment clinics and giving written information and a contact point may seem obvious but are currently overlooked in busy healthcare environments. This is an area where nurses can lead in the delivery of person-centred care and could potentially increase satisfaction with how waiting is managed.
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Affiliation(s)
- Caroline Fogarty
- Department of Colorectal Surgery, Adelaide and Meath incorporating National Children's Hospital, Dublin, Ireland.
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Manna G, Foddai E, Di Maggio MG, Pace F, Colucci G, Gebbia N, Russo A. Emotional expression and coping style in female breast cancer. Ann Oncol 2007; 18 Suppl 6:vi77-80. [PMID: 17591839 DOI: 10.1093/annonc/mdm231] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The study of the relationship of emotional status and tumor etiology has been investigated in order to elaborate a multifactorial model able to provide an answer integrating the different disciplines on cancer. The aim of this work is to investigate the knowledge on the alexithymia construct, exploring the presence of such trait in women affected by mammary carcinoma and analyzing the used coping strategies. The study has also examined personal thoughts related to event control (locus of control). METHOD The Toronto Alexithymia Scale, Coping Orientation to Problems Experienced, and Locus of Control questionnaires were administered to a group of 86 women aged 31-55 years (mean = 43.7; SD 6.57)-experimental group (N = 44): women with breast cancer diagnosed in the last 6 months; control group (N = 42): women without oncologic pathology, referred at the aforementioned institutions to undergo a breast check-up. RESULTS According to our hypothesis and literature data, a significant presence of alexithymic subjects (36.4% versus 2.4%; chi2 = 20.9; P < 0.0001) and a tendency to adopt coping strategies not focused on the problem were reported among women with mammary carcinoma. This causes incapability to act in order to actively contrast pathology-linked stress or to lower the effects. CONCLUSION Our results indicate that the tendency to repress one's emotions is associated to some general schemes of reaction to stress which, when used in a dysfunctional manner (such as the attempt to ignore how threatening an event is), are maladaptive in the end.
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Affiliation(s)
- G Manna
- Department of Psychology, Università di Palermo, Italy
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