Emotional distress reported by women and husbands prior to a breast biopsy

The purpose of this study was to describe the emotional distress of women (N = 300) and husbands (N = 265) prior to the women's breast biopsy and to identify factors related to their levels of distress. Standardized instruments were used to measure social support, uncertainty, marital satisfaction, family functioning, concurrent stress, hopelessness, and emotional distress. Women reported moderately high levels of emotional distress and significantly more distress than their husbands. Forty-two percent of the variance in women's distress scores and 42% of the variance in husbands' distress scores were accounted for by the independent variables. Concurrent stress, lower education, hopelessness, and uncertainty explained the most variance in women's distress, while concurrent stress, hopelessness, and family functioning explained the most variance in husbands' distress.

[Psychogenic paralysis of the arm after stereotactic brain biopsy]

A 45-year-old Turkish woman with a psychiatric history of depression and somatic disorder underwent an unnecessary stereotactic brain biopsy. After the procedure she developed severe palsy in the arm on the side of the operation without any somatic pathology. An integrative psychosomatic treatment approach focusing on the somatic problem improved the paralysis. Diagnostic and therapeutic issues in this case are discussed critically with reference to the literature.

Recalled anxiety: from discovery to diagnosis of a benign breast mass

PURPOSE/OBJECTIVES

To determine the amount of anxiety recalled by women who have had benign breast biopsies and to describe coping strategies used by these women during the time from discovery of the mass to definitive diagnosis.

DESIGN

Descriptive, retrospective.

SETTING

Surgical oncology practices, private and academic, treating patients living in five southern states.

SAMPLE

238 women who had excisional biopsies with benign results within the previous two years. Mean age of 52 years, 80% Caucasian, and 20% African American.

METHODS

Subjects rated their anxiety from discovery to diagnosis on a 16-point visual analogue scale and answered a short-answer question about the coping strategies used to deal with the anxiety.

MAIN RESEARCH VARIABLES

Anxiety and coping strategies.

FINDINGS

The mean length of time from discovery to diagnosis was 35 days. No statistically significant relationship was found between the length of time from discovery to diagnosis and the amount of anxiety experienced. However, 58% of the women recalled severe amounts of anxiety during this time. Qualitative analysis grouped coping strategies into five patterns (themes): diversionary, spiritual, interpersonal, hopeful, and avoidance.

CONCLUSIONS

The time between discovery of a breast mass and definitive diagnosis is a time of considerable anxiety for many women. Substantial time elapses between discovery and diagnosis, contributing to the possible morbidity associated with severe anxiety.

IMPLICATIONS FOR NURSING PRACTICE

Nurses can work to decrease the time occupied by the diagnostic process, counsel women regarding the anxiety being experienced, and present coping strategies that may help.

Coping with a breast cancer diagnosis: a prospective study

Employing the stress and coping theory of Lazarus and Folkman, this study followed 117 women age 40 or over regarding personality, cognitive appraisal, coping, and mood variables before breast biopsy, after diagnosis, and, for those who had cancer, after surgery. Upon biopsy, 36 received a cancer diagnosis, and 81 received a benign diagnosis. The 2 groups did not differ on appraisals, coping, or affect before diagnosis. With prebiopsy affect controlled, cancer patients reported more negative affect postbiopsy than did benign patients. Postsurgery, cancer patients expressed less vigor and more fatigue than benign patients, but the groups did not differ on other negative emotions. Prebiopsy, psychosocial predictors accounted for 54% and 29% of the variance in negative and positive emotion, respectively. Prebiopsy variables also predicted postbiopsy and postsurgery mood; cognitive avoidance coping was a particularly important predictor of high distress and low vigor.

Breast biopsy support program: collaboration between the oncology clinical nurse specialist and the ambulatory surgery nurse

Nurses play a vital role in the care of women admitted to an ambulatory unit for a breast biopsy. This paper offers one aspect of a psychosocial model that the oncology clinical nurse specialist and the ambulatory surgery nurse can use collaboratively to meet each woman's needs during this critical period. Goal-directed communications are the focus of this paper. Five specific techniques are described and can be used before biopsy reports are known, after women are informed that results are either negative or pending, and after reports are confirmed as positive. Psychosocial support is recognized as an important aspect of nursing care provided to women diagnosed with breast cancer. Although only 10% of women undergoing breast biopsies are diagnosed with malignant lesions, nurses must provide optimal support and guidance to every woman admitted for this surgical procedure.

Women, breast lump discovery, and associated stress

To learn about anxiety experienced by women before they undergo breast biopsy, we surveyed by telephone 42 females aged 18 or over who were scheduled for this procedure. Unlike other studies, the present investigation explores retrospectively the impact of the discovery of a breast lump, hospitalization, and factors that aggravate and alleviate anxiety. An interview guide and an adaptation of the Spielberger, Gorsuch, and Lushene (1970) State Trait Anxiety Inventory Scale were used for data collection. The stress and coping models developed by Lazarus and Launier (1978) and Lazarus and Folkman (1984) contributed to the conceptual framework used in this study. Findings indicate that the anxiety levels of women after the discovery of a breast lump and prior to knowledge of biopsy results were extremely high. Age and time delay in contacting the physician had a statistically significant relationship on the participants' stress levels. The findings provide information that contributes to understanding the problem of anxiety originating from the discovery of a breast lump.

Evaluation of the Pipelle curette for endometrial biopsy

The Pipelle endometrial suction curette was evaluated, and its application and effectiveness were compared to those of the Novak curette for endometrial sampling during the midluteal phase. Fifty women underwent an endometrial biopsy with the Pipelle and Novak curettes. Ninety percent of the women preferred the biopsy with the Pipelle. Histologically, tissue obtained with the Pipelle was satisfactory and similar to that with the Novak. The Pipelle curette appears to be an excellent device for midluteal endometrial biopsy during an infertility evaluation.

Influence of One- and Two-Stage Biopsy-Mastectomy Procedures on Psychologic Adaptation of Patients

To investigate the psychologic adjustment of women undergoing radical mastectomy for cancer, we compared drug consumption (analgesics and sedatives) in the postoperative period and the time lag between operation and the first spontaneous observation of surgical wound in two groups operated according to different procedures. Group 1 (52 patients; mean age, 47 years) underwent a two-stage surgical treatment consisting of biopsy (local anesthesia) followed after 2-4 h by mastectomy (general anesthesia); in the interval patients were informed about ongoing procedures by the surgeon, who also pronounced some key words such as tumor, malignant disease, cancer. Group 2 (66 patients; mean age, 47 years) underwent biopsy and mastectomy in a single stage under general anesthesia. The relative risk (RR) of Group 1 vs Group 2 patients was calculated as regards both drug consumption and time of the first self-observation of the surgical wound. Our results seem to suggest that the two-stage procedure through special care given by the surgeon may result in a positive coping pattern and thus better acceptance of the mutilation.

Psychological response to mastectomy. A prospective comparison study. Psychological aspects of Breast Cancer Study Group

This study reports data from 412 women prospectively studied over a 1-year period from five collaborating centers: one group had modified radical mastectomy for Stages I and II breast cancer, 145; cholecystectomy for gallbladder disease, 90; biopsy for benign breast disease, 87; and healthy women, 90. All were between the ages of 30 and 70 years, without pre-existing psychiatric illness and absence of current physical illness. All women were seen initially within 3 months of surgery. Data were analyzed from structured interviews, speech samples, and questionnaire responses which measured presence and degree of psychopathological symptoms, mood, physical complaints, self-esteem, and quality of interpersonal relationships. Principal components analysis was used to generate seven identifiable factors which were analyzed by MANOVA (multiple analysis of variance). Women with breast cancer showed greater psychological distress related to social and interpersonal relationships. More distress was seen in women with Stage II disease, and they also had more negative attitudes toward self and the future, concern with physical symptoms, anxiety, strain, and interpersonal difficulties. They did not, however, show any greater signs of psychopathological symptoms severe enough to warrant psychiatric intervention than the other groups over the year following surgery. The findings suggest that healthy women without prior psychiatric disorder or concurrent physical illness experienced some post-surgical distress, primarily in psychosocial functioning which was more than that in women after cholecystectomy or biopsy, but severe psychopathological symptoms over the year following surgery were conspicuously absent. These data do not support the belief that severe psychiatric sequelae follow a mastectomy in psychologically healthy women.

Skin testing and erythrocyte sedimentation rate in women undergoing breast biopsy

The purpose of this study was to determine the utility of skin testing and erythrocyte sedimentation rate (ESR) as measures of immune function in a population undergoing stress. Eight women were tested one week prior to breast biopsy and six were retested at least four weeks later. All biopsies were negative for malignancy. Control subjects were also tested four weeks apart. ESR values were elevated with stress but the magnitude of this effect was small. There were no differences between groups in skin test responses. Skin testing and ESR may have limited usefulness in the study of immune function in populations under stress.