Information needs and sources of information for women with breast cancer: a follow-up study

This paper reports a study which examined the specific information needs and sources of information for 105 women with breast cancer at two time points, the time of diagnosis and a mean of 21 months from diagnosis At diagnosis the priority information needs concerned survival issues Further from diagnosis survival issues were still a concern, but information about the risk to family members of getting breast cancer showed a significant increase in importance Information about sexual attractiveness was ranked last at both the newly diagnosed and follow-up stages Information sources at the time of diagnosis centred around the specialist breast care service, while further from diagnosis few professional or voluntary sector sources were utilized, with women receiving most of their information from media sources such as women's magazines The relevance of these findings for nurses and other health care professionals is discussed     

Promoting adjustment among women with breast cancer and their partners: a program of research

A three-phase program of research consisted of: (1) data collection at eight data points across one year on predictors and outcomes of adjustment among 128 women diagnosed with breast cancer and 121 partners; (2) development of phase-specific interventions: standardized education by videotape (SE), and telephone counseling (TC); and (3) a pilot study among 12 patient-partner pairs. Four phases were identified: diagnostic, post-surgical, adjuvant therapy, and ongoing recovery. Needs were categorized as those related to: (1) physical well-being, (2) emotional well-being; (3) support; and (4) the healthcare system. In the pilot study, each group consisted of 4 patient-partner pairs, randomly assigned to one of four groups. At each of the four phases, all groups received the currently accepted disease management (DM). Group 1: DM * Group 2: DM+SE * Group 3: DM+TC * Group 4: DM+SE+TC. Measures of outcomes validated in the longitudinal study were administered. The feasibility of a confirmatory randomized clinical trial was demonstrated. Preliminary evidence indicates the importance of research-based, phase-specific educational and counseling interventions that have a positive effect on adjustment among both patients and their families.     

Participatory research in breast cancer: a case study in regional Victoria

While participatory research is now strongly advocated as progressive, ethical and useful, consultation with participants and other stakeholders can raise issues which compromise research or which create conflicting choices in research protocols. This paper discusses some of the issues raised by a participatory research project undertaken to assess the needs of women with breast cancer in northern Victoria. The participatory process has meant that despite some compromises, there were positive outcomes from the research process that would not have otherwise been achieved.     

Depression and anxiety in women with breast cancer and their partners

BACKGROUND: Psychosocial interventions can improve psychological quality of life (symptoms of depression and anxiety) of both women with breast cancer and their partners, but are not offered routinely to women and their partners. OBJECTIVE: To test the hypotheses that telephone-delivered psychosocial interventions decrease depression and anxiety in women with breast cancer and their partners. METHODS: The design of the study was a three-wave repeated measures with a between-subjects factor (treatment group). Ninety-six women and their 96 partners were assigned randomly to participate in one of three different 6-week programs: (a) telephone interpersonal counseling (TIP-C); (b) self-managed exercise; or (c) attention control (AC). RESULTS: The mixed-model analysis of variance for symptoms of depression among women with breast cancer revealed women's depressive symptom scores decreased over time in all groups. For anxiety, women's symptoms of anxiety decreased in the TIP-C and exercise groups over time, but not in the AC group. A parallel set of analyses was conducted on partners' depression and anxiety data. Symptoms of depression and anxiety among the partners decreased substantially over the course of the investigation. Similar to the women, partners' symptoms of anxiety decreased significantly in the TIP-C and exercise groups, but not in the AC group. DISCUSSION: Findings from this study support that these telephone-delivered psychosocial interventions were effective for decreasing symptoms of depression and anxiety to improve psychological quality of life when compared to an AC group.     

Pilot study of the breast cancer experiences of African American women with a family history of breast cancer: implications for nursing practice

Experts in the area of breast cancer detection and control recommend that women at increased risk discuss their risk status and risk management with their health care providers. In spite of the excessive breast cancer burden borne by African American women, little attention has been given to studying breast cancer risk communication and/or breast cancer risk management in this at-risk population group. This report summarizes the outcomes of a study undertaken to explore the degree to which breast cancer, breast cancer risk, and breast cancer risk management were discussed by African American women and their health care providers Targeted for inclusion in the study were African American women who had a first degree relative or multiple second degree relatives that had been diagnosed with pre-menopausal breast cancer. Of particular interest was the extent to which African American women with a family history of breast cancer perceived themselves to be at risk for developing breast cancer and the extent to which they discussed their family history, their breast cancer risk, and, breast cancer risk management with their providers.     

A case for case studies: exploring the use of case study design in community nursing research

The case study has become an accepted vehicle for conducting research in a variety of disciplines. However, the meaning behind the term is not always made explicit by researchers and this has given rise to a number of assumptions which are open to challenge, and to questions about the robustness of the method. This paper explores some of the issues arising from one particular definition of case study research, used in a study by Yin which examined the practice of case management in community nursing. Four main areas are discussed. First, defining 'case' is seen to pose questions about the relationship of the phenomenon to its context, the degree of researcher control over case definition, the limits to what may constitute a 'case' and what is meant by the term 'unit of analysis'. Second, the relevance of external validity to case study research is supported through the use of a number of tactics, in particular Yin's concept of replication logic, which involves generalizing to theory, rather than to empirical data. Third, the use of method triangulation (multiple methods of data collection) is advanced as a means of enhancing construct validity in research where data converge around a particular theory. Finally, the relationship of the case study to theory construction, through the prior development of 'propositions' is discussed. Each of these issues is applied to the design and conduct of a research study based closely on Yin's multiple case study framework. Thirteen 'cases' were selected of case management practice and data were collected through interviews and examination of literature and documentation, to explore the suitability of community nurses for the role. It is concluded that, given the appropriate subject matter, context and research aims, the case study method may be seen as a credible option in nursing research.     

The information needs of women newly diagnosed with breast cancer

Nurses can play a key role in patient education, including providing patients with useful and approrate information Rather than focusing on the process of education or information giving by nurses, this study places emphasis on the content of that information by taking the patients'perspective and asking the patients themselves what particular types of information are perceived as important at a specific point in time The aim of the study was to explore what particular types of information were important to women newly diagnosed with breast cancer, to enable nurses and other health care professionals to utilize their time as effectively as possible and provide a high-quality service to individuals in their care Women with breast cancer (a mean of 2 5 weeks from diagnosis) were interviewed and asked to compare items of information The items of information were presented m pairs and the women stated a preference for one item in that pan- Thirty-six pairs were presented in total The analysis involved the use of a Thurstone scaling model, which allowed rank ordermgs, or profiles of information needs, to be developed, reflecting the perceived importance of each item Information about the likelihood of cure, the spread of the disease and treatment options were perceived as the most important items of information at the tune of diagnosis Other information needs, in order of descending priority, included information about the risk to family, side-effects     

Hypnosis for symptom management in women with breast cancer: a pilot study

Eight women who were in treatment for breast cancer (n = 4) or breast cancer survivors (n = 4), presenting with 1 or more of 4 symptoms (chronic pain, fatigue, hot flashes, and sleep difficulties), were given 4 to 5 sessions of self-hypnosis training for symptom management. Analyses revealed (a) significant pre- to posttreatment decreases in pain intensity, fatigue, and sleep problems and (b) that pain intensity continued to decrease from posttreatment to 6-month follow-up. Although there was a slight increase in fatigue severity and sleep problems from posttreatment to 6-month follow-up, the follow-up scores did not return to pretreatment levels. The findings provide initial support for using hypnosis to manage symptoms in women who are breast cancer survivors. Clinical trials evaluating hypnosis efficacy over and above other treatments are warranted.     

Ambiguity and uncertainty: The ongoing concerns of male partners of women treated for breast cancer.

As the prevalence of breast cancer increases, survival improves and short stay or outpatient care become the norm, greater numbers of men will be involved in providing care and support for their partners at home. This qualitative study explored the experiences of 26 male partners of women who had completed treatment for breast cancer. A questionnaire was developed in order to collect background information and to provide a pool for further qualitative sampling. One hundred and five questionnaires were distributed, 79 returned and 26 one-to-one interviews were conducted. While negotiating a role in their wives' breast cancer experience the men attempted to find a balance between the ambiguity and uncertainty they experienced and their need to maintain normality. They described feeling 'in limbo' when expectations of being able to move on following their wives treatment were not fulfilled. An understanding of the 'liminal' experience of being a male partner of a woman with breast cancer may help health care professionals to address the ongoing difficulties men encounter. This is important as it is often the male partners who are called upon to provide continued care and support beyond the recognised treatment period.     

Yoga for women with metastatic breast cancer: results from a pilot study

Metastatic breast cancer (MBC) remains a terminal illness for which major treatment advances are slow to appear, and hence it is crucial that effective palliative interventions be developed to reduce the cancer-related symptoms of women with this condition during the remaining years of their lives. This pilot/feasibility study examined a novel, yoga-based palliative intervention, the Yoga of Awareness Program, in a sample of women with MBC. The eight-week protocol included gentle yoga postures, breathing exercises, meditation, didactic presentations, and group interchange. Outcome was assessed using daily measures of pain, fatigue, distress, invigoration, acceptance, and relaxation during two preintervention weeks and the final two weeks of the intervention. Thirteen women completed the intervention (mean age=59; mean time since diagnosis=7 years; two African American, 11 Caucasian). During the study, four participants had cancer recurrences, and the physical condition of several others deteriorated noticeably. Despite low statistical power, pre-to-post multilevel outcomes analyses showed significant increases in invigoration and acceptance. Lagged analyses of length of home yoga practice (controlling for individual mean practice time and outcome levels on the lagged days) showed that on the day after a day during which women practiced more, they experienced significantly lower levels of pain and fatigue, and higher levels of invigoration, acceptance, and relaxation. These findings support the need for further investigation of the effects of the Yoga of Awareness Program in women with MBC.     

The use of research findings in bereavement programs: a case study

Violent death is a major public health problem in the United States, yet there is no consensus among bereavement researchers and clinicians regarding a "gold standard" of bereavement services to be offered to family survivors. This article has three purposes: (a) to describe the planning, implementation, and results of a theory-based intervention study involving parents bereaved by the violent deaths of their children; (b) to suggest programmatic elements of bereavement services based on some findings from both the bereavement program and the follow-up data obtained from parents up to 5 years postdeath; and (c) to identify future research and theory development needs. The results of the intervention study involving 261 bereaved parents provide helpful insights regarding parent bereavement program preferences as well as changes in parent outcomes. Some of the most relevant findings pertain to variability in distress levels, gender, and causes of deceased children's deaths. Findings suggest that many different types of services are needed to meet parents' needs. The follow-up data collected from the parents 1, 2, and 5 years postdeath demonstrate that loss accommodation following violent death bereavement is both lengthy and difficult. Recommendations follow for both bereavement services and research studies.     

Meeting the information needs of women with breast cancer: Piloting a nurse-led intervention

This study evaluated a telephone intervention, administered by specialist breast care nurses, that aimed to meet the information needs of women with breast cancer. The intervention was developed from previous work that examined priority information needs. Participants were allocated to a telephone intervention (n = 67) or control group (n = 68). Data were collected by means of semi-structured interviews with participants at two time points (3 months and 8-12 months post-diagnosis) and focused on patient satisfaction with sources of information, information needs and psychological morbidity. Interviews were also conducted with breast care nurses to ascertain their views on administering the intervention. The intervention group reported fewer physical problems at Time 2 and were more likely to have had their information needs met than women in the control group. The control group were more likely to utilise media sources of information at Time 2 whereas women in the intervention group reported breast care nurses as their most prominent source of information. There were no significant differences in psychological morbidity between the two study groups. The findings indicate that the intervention is a feasible and acceptable approach to meeting the information needs of women with breast cancer. Further research is required to evaluate the intervention in a randomised controlled trial.     

Interpersonal well-being and mental health among male partners of women with breast cancer

The focus of this investigation was on the mental health of men whose partners had recently been diagnosed with breast cancer. In accord with theoretical models that specify the importance of interpersonal relationships in maintaining mental health, men's relationship satisfaction and perceptions of social support were predicted to be positively associated with their mental health during this stressful time. The sample included 63 male partners of women with breast cancer who participated in a three-wave panel study that assessed various indicators of mental health and interpersonal well being at T1, T1 + 6 weeks, and T1 + 10 weeks. Results indicated substantial distress in at least 25% of the men. However this distress subsided over time. Relationship satisfaction was both concurrently and prospectively associated with better mental health. Social support was negatively associated with concurrent mental health but post hoc analyses suggested that men's social networks perhaps provide greater social support to the extent that the men are emotionally distressed.     

Living with newly diagnosed breast cancer: a qualitative study of 10 women with newly diagnosed breast cancer

AIM: The aim of this qualitative study was to describe from the perspective of 10 women (aged 39-69 years), their experience of living with breast cancer. BACKGROUND: Although there is increasing research into a variety of aspects associated with breast cancer, there is a continuing need for research to increase nurses' understanding of how women experience living with newly diagnosed breast cancer. DESIGN/METHODS: Following ethical approval, open-ended interviews were analysed, using methods influenced by Grounded Theory. Verifiability and empirical grounding of the theory was established through use of the constant comparative method. FINDINGS: Existential issues arose as an important aspect of living with newly diagnosed breast cancer. The will to live emerged as the central theme. All energy was channelled into a tenacious fight for life. Furthermore, results revealed other aspects in the women's awareness of living with breast cancer, such as their experiences in relation to emotional reactions, bodily physical changes, their female identity, meaningful activities and their social network. CONCLUSIONS: An understanding of how women experience their new and changed life situation is important to the support nurses give in the process of healing. Nurses need this knowledge to be better able to assist women and their families in their development of coping strategies.     

Coping with radiation therapy: Effects of a nursing intervention on coping ability for women with breast cancer

A randomized study was carried out to investigate whether a nursing intervention, using Orem's self-care theory as a framework, would affect the coping ability of women with breast cancer during and following radiation therapy. The intervention consisted of promoting of behaviours to support the patient to restore, maintain or increase their abilities to interact with the situation and adapt to the demands of radiation treatment. The control and experimental groups both consisted of 67 patients. The Wheel Questionnaire was used to evaluate the effect of the intervention. Our results showed that the intervention provided patients older than 59 years the ability to cope with the treatment (df = 2, F = 3.463, P = > 0.05). The present study supports the idea that individual interventions aimed at improving well-being helps patients. It also highlights the fact that individual approaches to improving well-being are needed. Such interventions should be directed to patients at risk for poor adjustment, such as those older than 50 years of age.     

The Internet: an effective tool for nursing research with women

This article outlines the methodology of using the Internet to survey an international population of women about their perceptions of breast health education and screening. Issues to consider in planning and implementing the research project by Internet are presented. A large population of women from North America and elsewhere was reached through the establishment of a website with linkages to other sites frequented by women. Women who visited the website were asked to complete a questionnaire. Anonymity was guaranteed and simple instructions were provided at the site. Benefits, limitations, and tips for success in using the Internet as a research tool are presented. These investigators found the Internet to be an appropriate medium for health-related research that also garnered national and international media interest. The address for this website is http:@www.uwindsor.ca/breast.study/quest.htm.