Psychosocial care and breast cancer

Observations of professional-patient relationships: a mixed-methods study exploring whether familiarity is a condition for nurses' provision of psychosocial support

BACKGROUND

There is a popular belief that the professional-patient relationship is a prerequisite in the provision of psychosocial support. Studies suggest that professionals must know, or be familiar with, a patient in order to effectively provide psychosocial support.

AIM

To examine the association between familiarity and the provision of psychosocial care by professionals.

DESIGN

A mixed-methods study involving participant observation, interviews and organisational and documentary analysis was conducted over 8 months in an inpatient hospice setting.

PARTICIPANTS

In total, 38 nurses (registered and auxiliary) and 47 patients were included in a maximum variation sampling strategy. Data were analysed using both qualitative and quantitative techniques.

RESULTS

The data disconfirm the belief that familiarity is either a necessary or sufficient condition for the provision of psychosocial support. Nurses familiar with patients did not necessarily respond to patients' psychosocial needs, and nurses with no prior contact with the patient immediately dealt with psychosocial needs.

CONCLUSION

Psychosocial support can be provided on a patient's first contact with a clinician and does not rely on building a professional-patient relationship. This suggests that high-quality psychosocial care can be provided in the short time frame available to palliative care clinicians.

Going the distance--experiences of women with gynaecological cancer residing in rural remote north Queensland

Women who are diagnosed with gynaecological cancer face a difficult journey. For women residing in areas geographically removed from major health providers the journey can be much more difficult. While they 'make do' and 'struggle on', their lived experiences can provide valuable insight into the complex issues surrounding a cancer diagnosis in rural areas. This study aimed to understand their experiences through the women's stories and sought to identify the major themes impacting on these stories. This qualitative phenomenological study undertook interviews with seven women with gynaecological cancer who reside in rural and remote north Queensland. Analysis of the data collected revealed three themes: seeking answers at a distance; sharing information within a small community; and experiences of navigating the health system. The results show the inherent difficulties in accessing support in rural areas and the difficulties associated with travelling considerable distances to undergo treatment.

The psychosocial concerns and needs of women recently diagnosed with breast cancer: a qualitative study of patient, nurse and volunteer perspectives

OBJECTIVE

To qualitatively identify the concerns and needs of Australian women recently diagnosed with breast cancer.

BACKGROUND

Breast cancer diagnosis can lead to impairment in multiple areas of psychosocial well-being, including physical, social and emotional functioning. Research has therefore begun to focus on identifying and addressing survivors' concerns and needs, with most research examining the time of treatment completion. However diagnosis and treatment are also key times of psychological need, and less is known about the psychosocial concerns and needs at these times.

RESEARCH DESIGN

Seven focus group interviews were conducted examining three categories of participants: (i) patients diagnosed with early-stage breast cancer within the past 12 months, (ii) oncology nurses, and (iii) volunteers who work with cancer patients. Sampling was discontinued when informational redundancy was achieved.

SETTING AND PARTICIPANTS

Thirty-four participants took part in one of seven focus group meetings held in a hospital patient resource room.

RESULTS

A wide variety of psychosocial concerns and needs were discussed, and five specific areas of concern were identified: (i) coping with side-effects; (ii) dealing with self-concept change; (iii) stress and adjustment reactions; (iv) having to manage others' unhelpful beliefs, expectations and emotions; and (v) issues with survival and growth. There was a large degree of consistency in the concerns and needs identified by the different group categories.

CONCLUSION

In general, the concerns and needs expressed were consistent with survivorship issues previously identified in the literature; however, several new insights were obtained. Clinical implications of these findings are discussed.

Coping with Cancer

Although psychosocial coping techniques and supportive care services have been shown to improve cancer patients' quality of life, there is evidence that many of these strategies have not been widely integrated into the routine care of cancer patients. This study examined: (1) the extent to which cancer patients use certain coping strategies; (2) reasons for non-use; (3) perceived effectiveness of the coping strategies; (4) participants' interest in trying the strategies; and (5) if the strategies were recommended to participants. At the Northwestern Ontario Regional Cancer Centre in Thunder Bay, Ontario, Canada, 292 outpatients (98% response rate) completed an in-person interview with a research assistant concerning seven individual coping strategies (music, breathing exercises, meditation, prayer, muscle relaxation, visualization/imagery, hypnosis/self-hypnosis) and four coping strategies offered through supportive care services (individual counselling, family counselling, support groups, religious support). Of all the coping strategies presented, prayer was used by the highest number (n = 186) of participants (64%). Music was the next most commonly used strategy, used by 43% (n = 124) of participants, and all other strategies were used by less than 30%of participants. The individualized approaches that are used for disseminating disease and treatment information to cancer patients should also be used to provide them with information on effective coping strategies.

CBT for emotional distress of people with cancer: some personal observations

The detrimental effect of a helpless coping response on the quality of life of cancer patients is well documented. Helplessness is significantly related to emotional distress. There is also evidence that this coping response is an independent prognostic factor associated with a significantly increased risk of disease recurrence and death. These findings highlight the need to develop specific strategies to enable patients to overcome helplessness. Recent research in patients with advanced cancer indicates that emotional distress appears to be caused by low levels of positive effect. Consequently, attention should be paid to the much neglected study of positive psychological states such as fighting spirit and resilience. In the meantime, some suggestions-based on clinical experience-of inducing and fostering positive effect in our patients are outlined.

Predicting worry following a diagnosis of breast cancer

Measures identified in research as being predictive of later worry following a cancer diagnosis may be too time consuming for routine clinical screening purposes. In practice, therefore, clinicians may use factors such as disease severity to anticipate likely distress. In this study we evaluated alternative predictors based on simple ratings that we had found useful with other patient groups.

METHODS

Women attending a breast clinic were briefly interviewed on three occasions about their worries: in the clinic immediately before diagnosis and twice after diagnosis, two and four months later. Severity of disease was established using the Nottingham Prognostic Index (NPI).

RESULTS

Severity as assessed by the NPI was not highly correlated with post-diagnostic health worries. The factor found to be most highly correlated with subsequent worry about cancer was patients' ratings of the frequency of thinking about the initial clinic visit during the preceding week.

CONCLUSION

Given the relative ease of asking about level of pre-diagnostic intrusive thoughts, we conclude that this index would provide a useful and practical method for clinicians to identify in advance those patients likely to worry excessively following a diagnosis of cancer.

Psychosocial issues in breast cancer

The breast cancer experience can bring with it a broad range of emotional sequelae for the woman, her spouse/partner, and her family. Often, patients bear these emotional burdens silently and miss opportunities for the physician and health care team to offer recommendations and interventions for her and her family. The proactive physician evaluating these potential difficulties and using the strength a good relationship with the patient in making appropriate referrals for counseling or support group does much to help the woman embrace as full a recovery as possible. Recommendations presented by the woman's physician are most often heeded. The physician must intervene on behalf of the woman to ensure that psychosocial support needs are met. Physicians are encouraged to adopt this orientation and to use an integrated approach in caring for the woman with breast cancer. (6)

Dietary change after breast cancer: extent, predictors, and relation with psychological distress

PURPOSE

Some women may try to cope with breast cancer by making lifestyle modifications, possibly in the hope of improving disease outcome. We assessed extent, predictors, and effect on psychological distress of dietary changes in the year after diagnosis among 250 women with newly diagnosed, nonmetastatic breast cancer.

PATIENTS AND METHODS

Data came from medical records, and from interviews 3 days and 12 months after initial treatment.

RESULTS

At 12 months, 41% (n = 103) reported dietary changes at some time since diagnosis, with decreases in meat (77%) and increases in fruit and vegetable intake (72%) being the most frequent. Women reporting changes were more likely to be younger, to have positive nodes, to be receiving adjuvant therapy, and to be more distressed initially. The mean 0 to 12 month decrease in psychological distress was greater in women who reported changes (9 points) than those who did not (4.7 points) (P =.03), although regression toward the mean cannot be excluded.

CONCLUSION

A sizable proportion of women made dietary changes on their own initiative. Most changes reported were generally consistent with current scientific hypotheses about dietary changes that might favorably affect prognosis. The profile of women reporting changes suggests a group with more concerns about recurrence, who may have initiated dietary change to help cope with and gain a sense of control over the disease, and possibly to improve prognosis. Our results suggest that newly diagnosed women could be receptive to explicit attention to diet as part of psychosocial care. However, this interest in dietary change may not, as yet, have been maximally channeled into trying to improve the care and quality of life of women facing diagnosis, treatments, and fears about recurrence.

Novice and expert perceptions of psychological care and the development of psychological caregiving abilities

Despite the wealth of research pointing to the centrality of psychological care in illness, there appears to be a lack of consensus concerning its nature and the means by which psychological caregiving abilities are acquired. This has an impact on nurse educators, who must identify and harness the perceptions which students hold, and identify the processes which might contribute to their skill development, as they progress from 'novice' to 'expert'. The aims of this small qualitative study were to compare novice and expert perceptions of the nature of psychological care, and to identify those processes that may contribute to nurses' ability to apply psychological understanding in practice. Data collection methods comprised interactive interviews with qualified and novice student nurses, which were analysed thematically using an adaptation of Colaizzi's (1978) reductive procedure. Results suggest that, whilst there is considerable overlap in themes identified between the two groups, novices consider a broader range of themes to be central to psychological caregiving than do experts; similarly, novices identify more contributory factors than do experts in explaining the process of acquiring skill in psychological caregiving. Possible reasons for these differences are considered. Whilst this study is limited in size and scope, the ultimate goal is to utilize central themes within a model of psychological caregiving, which might inform nurse education. In this way, educational programmes might be appropriately focused upon students' needs within the context of real clinical experience.

Taping outpatient consultations: a survey of attitudes and responses of adult patients with ocular malignancy

PURPOSE

To study the attitudes and responses of cancer patients to audiotaped consultations as a communication aid in an ophthalmic clinic.

METHODS

Ninety-four patients attending an ocular oncology clinic were given an audiotape of their initial consultation. They were then administered a structured interview with questionnaire regarding their views on the tape when they attended an outpatient clinic for follow-up after surgery or radiotherapy.

RESULTS

91% of patients had listened to the tape at least once, often prior to their treatment or follow-up visit. Most patients had shared the tape with immediate relatives, including their spouse (58%) or other family members (45%). Of those who had listened to the tape, 94% described it as very useful or quite useful in helping them understand their condition. The majority had found it valuable in helping them understand their treatment and its side-effects, in reducing their fears and anxieties and in their emotional and psychological adjustment to their illness. Most commented on the tape as a valuable communication aid to the consultation process.

CONCLUSIONS

Taping of the consultation as a method of improving communication is popular among cancer patients. The vast majority benefit greatly from being able to hear their consultation again in their own time.