Process of Coping with Mastectomy: a Qualitative Study in Iran

Abstract Background: Breast cancer is the most prevalent cancer among Iranian women and mastectomy comprises 81% of surgeries for treatment of breast cancer. Mastectomy may create feelings such as deformation or impairment in patients, cause body-image disorder, and reduce sexuality and sexual activity which in turn may entail mental disorders. The study aimed to elaborate coping processes. Materials and Methods: A grounded theory method was used in conducting this study. Twenty Iranian participants undergoing mastectomy were recruited with purposive sampling. An open, semi-structured questionnaire were developed. Obtaining consent, conversations were recorded and immediately transcribed after each session. Data analysis was carried out with the constant comparative method using the Strauss Corbin approach. Results: Analyzing the collected data, the study came up with seven main categories which affected the coping process in patients with breast cancer, namely: reactions to mastectomy; loss and death contest; reconstruction of evaluation system; consent for undergoing mastectomy; reactions and troubles after loss; confrontation of loss and health; and reorganization and compatibility with changes. Conclusions: The results of the study indicated: when patients become informed of their breast cancer and the necessity of undergoing mastectomy as the treatment, they probably pass through seven categories to adapt after mastectomy. Having insight about them is likely to contribute medical personnel in leading patients to the highest degree of feeling healthy

Developing a digital intervention for cancer survivors: an evidence-, theory- and person-based approach

This paper illustrates a rigorous approach to developing digital interventions using an evidence-, theory- and person-based approach. Intervention planning included a rapid scoping review which identified cancer survivors’ needs, including barriers and facilitators to intervention success. Review evidence (N=49 papers) informed the intervention’s Guiding Principles, theory-based behavioural analysis and logic model. The intervention was optimised based on feedback on a prototype intervention through interviews (N=96) with cancer survivors and focus groups with NHS staff and cancer charity workers (N=31). Interviews with cancer survivors highlighted barriers to engagement, such as concerns about physical activity worsening fatigue. Focus groups highlighted concerns about support appointment length and how to support distressed participants. Feedback informed intervention modifications, to maximise acceptability, feasibility and likelihood of behaviour change. Our systematic method for understanding user views enabled us to anticipate and address important barriers to engagement. This methodology may be useful to others developing digital interventions

The shifting nature of women’s experiences and perceptions of ductal carcinoma in situ

Aim: This paper is a report of a descriptive qualitative study of the evolution of women’s perceptions and experiences of ductal carcinoma in situ from the period near to diagnosis to one year later. Background: Ductal carcinoma in situ is a non-invasive breast condition where cancer cells are detected but confined to the ducts of the breast. With treatment, the condition has a positive prognosis but ironically patients undergo treatment similar to that for invasive breast cancer. There is a lack of longitudinal qualitative research studying women’s experiences of ductal carcinoma in situ, especially amongst newly diagnosed patients and how experiences change over time. Methods: Forty-five women took part in an initial interview following a diagnosis of ductal carcinoma in situ and twenty-seven took part in a follow-up interview 9-13 months later. Data were collected between January 2007 and October 2008. Transcripts were analysed using a hybrid approach to thematic analysis. Findings: Women’s early perceptions of ductal carcinoma in situ merged and sometimes conflicted with their lay beliefs of breast cancer. Perceptions and experiences of the condition shifted over time. These overriding aspects were evident within four themes identified across the interviews: 1) perceptions of DCIS versus breast cancer, 2) from paradox to acceptance, 3) personal impact, and 4) support and interactions with others. Conclusion: This study represents one of the few longitudinal qualitative studies with newly diagnosed patients, capturing women’s initial and shifting experiences and perceptions of the condition. The issues identified need to be recognised in clinical practice and supported appropriately

Broadening Our Perspective on Spirituality and Coping among Women with Breast Cancer and their Families: Implications for Practice

The purpose of this paper is to illustrate the role of spirituality in coping among women with breast cancer and their families. This phenomenological study was guided by family systems theory and the recognition that a family is a complex system whereby family members interact with one another as well as with the outside world. A change in any of these interactions/relationships can affect the rest of the system, and the diagnosis of breast cancer in mothers within the family system is no exception. Five families (five women, five men and six children) comprising a total of 16 participants took part in this study. The women in this study reported using a number of methods to cope with their illness, one of which was utilising their spiritual beliefs. Although they placed a great deal of importance upon their spiritual beliefs, their families did not. The implications of this reality upon nursing practice will be discussed here

Breast Cancer Survivorship Rehabilitation Initiative: Community Report

The Breast Cancer Survivorship Rehabilitation Initiative (BCSRI) conducted an assessment of breast cancer survivorship services in the Greater Birmingham area, including Blount, Jefferson, Shelby, St. Clair, and Walker counties, over the course of four (4) months. Project staff disseminated surveys and conducted one-on-one interviews with self-identifying respondents. Following the conclusion of both the surveys and interviews, discussion groups were held. An Ad Hoc Committee was then formed from a group of community leaders and experts in the field of cancer survivorship to review the data and provide feedback. The BCSRI also conducted interviews with the directors of 12 cancer survivorship programs throughout the country. The aggregated data was presented in monthly meetings to a leadership team consisting of executive level hospital administrators in the Greater Birmingham area.This report will summarize the data and serve as a resource to develop programs throughout the community to provide breast cancer survivorship care and patient advocacy. Next steps include developing the infrastructure needed to build a survivorship program that will meet the needs of breast cancer survivors in the Greater Birmingham area, and potentially become a model that can be replicated for other cancer types and diseases or for breast cancer survivors in other communities

Conversations about creativity and chronic illness II: Textile artists coping with long-term health problems reflect on the creative process

This qualitative study explored the origins of interest in textile arts among a group of women living with long-term health problems. The part that illness played in motivating engagement in creative arts was of particular concern. Twenty four women were interviewed, aged between 29-72 years. Most were hobbyists and but the sample included some publicly acclaimed textile artists. A minority had engaged in art continuously since their earlier years. Most of the women had discovered (or re-discovered) textile arts, in middle and later life. Several factors facilitated this. The narratives indicated that the women’s pre-existing resilient personality as well as extensive support structures may have encouraged a reflective attitude and a problem-solving approach to living with illness. The experience of biographical disruption, stemming from the crisis of illness, dissatisfaction with unproductive time and a growing need for self-fulfilment, appeared to create a search for a meaningful occupation. The discovery of textile art as a meaningful occupation (as opposed to other ways of living with illness) appeared to be encouraged by early role models, enjoyment of art at school, the discovery that adult personal and professional interests could be expressed through artwork, and chance events. Textile art at school appeared to provide a form of ‘cultural capital’ for these women, who returned to this art medium and the skills learned earlier, when crisis occurred. The findings indicate that a negative event such as illness may have life-enhancing effects. Rehabilitation specialists might focus more on the arts as a resource for adults living with illness

Expanded Behavioral Model for Online Support Services

The rapid expansion of online technologies and health resources has created opportunities to develop broadly available interventions to address the needs of the modern patient. This study proposes a theoretical structure based on Andersen\u27s Individual Determinants of Health Service Utilization Model to describe who is using online support and how it is being used. Also unique to this analysis was the use of objective behavioral data to describe and predict website utilization, and linguistic analysis to evaluate the content of what is shared in online groups. Eighty-four men and women completed baseline evaluations and were randomized into either online support or a waiting-list control condition. The overall theoretical structure did not produce a significant model; however the individual variables education, past online experience, and time spent online were predictive of participation. The somewhat unexpected finding that those with no prior online group experience and those who were high school educated were more likely to participate is discussed. If replicated, these findings may lend support to the idea that online interventions could provide needed support to individuals who do not typically participate in face-to-face interventions, and that the barriers to online group participation are not the same as the barriers for face-to-face group participation

Wearable activity technology and action-planning (WATAAP) to promote physical activity in cancer survivors: Randomised controlled trial protocol

Background/Objective: Colorectal and gynecologic cancer survivors are at cardiovascular risk due to comorbidities and sedentary behaviour, warranting a feasible intervention to increase physical activity. The Health Action Process Approach (HAPA) is a promising theoretical frame-work for health behaviour change, and wearable physical activity trackers offer a novel means of self-monitoring physical activity for cancer survivors. Method: Sixty-eight survivors of colorectal and gynecologic cancer will be randomised into 12- week intervention and control groups. Intervention group participants will receive: a Fitbit AltaTM to monitor physical activity, HAPA-based group sessions, booklet, and support phone-call. Participants in the control group will only receive the HAPA-based booklet. Physical activity (using accelerometers), blood pressure, BMI, and HAPA constructs will be assessed at baseline, 12-weeks (post-intervention) and 24-weeks (follow-up). Data analysis will use the Group x Time interaction from a General Linear Mixed Model analysis. Conclusions: Physical activity interventions that are acceptable and have robust theoretical underpinnings show promise for improving the health of cancer survivors