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Palmer Kelly E, McGee J, Klatt M, Beckers G, Pawlik TM. The Use of Brief Mindfulness Interventions in the Context of Perioperative Care. Am Surg 2024; 90:1657-1665. [PMID: 38282339 DOI: 10.1177/00031348241230092] [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] [Indexed: 01/30/2024]
Abstract
The purpose of this review was to synthesize and categorize the literature on the use of brief mindfulness interventions for both patients and physicians across the spectrum of perioperative care. Web-based discovery services and discipline-specific databases were queried. Brief mindfulness interventions were defined as sessions lasting 30 min or less on any single occasion, with a total practice accumulation not exceeding 100 min per week, and a duration of up to 4 weeks. Study screening and data extraction were facilitated through the Covidence software platform. After screening 1047 potential studies, 201 articles were identified based on initial abstract and title screening; 10 studies ultimately met inclusion criteria. All ten studies were published between 2019 and 2023; most (n = 9) reports focused on patients (total joint arthroplasty, n = 3; stereotactic breast biopsy, n = 2; minimally invasive foregut surgery, n = 1; septorhinoplasty, n = 1; cardiac surgery, n = 1; and other/multiple procedures, n = 1); one studied investigated mindfulness interventions among surgeons. The duration of the interventions varied (3 min to 29 min). The most common issue that the mindfulness intervention aimed to address was pain (n = 6), followed by narcotic use (n = 3), anxiety (n = 2), delirium (n = 1), or patient satisfaction (n = 1). While most studies included a small sample size and had inconclusive results, brief mindfulness interventions were noted to impact various health-related outcomes, including mental health outcomes, anxiety, and pain perception. Mindfulness interventions may be a scalable, low-cost, time-limited intervention that has the potential to optimize well-being and surgical outcomes broadly construed.
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Affiliation(s)
- Elizabeth Palmer Kelly
- The Ohio State University Wexner Medical Center, The James Comprehensive Cancer Center, Department of Surgery, Columbus, OH, USA
| | - Julia McGee
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Maryanna Klatt
- Center for Integrative Health, Department of Family and Community Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Grateful Beckers
- The Ohio State University Wexner Medical Center, The James Comprehensive Cancer Center, Department of Surgery, Columbus, OH, USA
| | - Timothy M Pawlik
- The Ohio State University Wexner Medical Center, The James Comprehensive Cancer Center, Department of Surgery, Columbus, OH, USA
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Aredo JV, Tandon HK, Panahi S, Phan VT, Ameli R, Karp BI, Stratton P. Mindfulness in Facilitating Pelvic Floor Botulinum Toxin Injection in Women with Chronic Pelvic Pain. Toxins (Basel) 2024; 16:216. [PMID: 38787068 PMCID: PMC11126137 DOI: 10.3390/toxins16050216] [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: 03/19/2024] [Revised: 04/19/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024] Open
Abstract
Botulinum toxin (BoNT) injection can safely be done as an office-based procedure, but can be painful itself, especially when injecting pelvic floor muscles to treat chronic pelvic pain (CPP). Mindfulness interventions may reduce procedure-associated acute anxiety and pain. We applied mindfulness techniques to increase the tolerability of office-based pelvic floor BoNT injections in women with CPP. Women enrolled in a clinical trial of BoNT for endometriosis-associated CPP were offered a brief, guided mindfulness session before and/or after transvaginal injection. Anxiety, pain, and dysphoria were rated on a 0-10 numerical rating scale (NRS) before and after each mindfulness session. Eight women underwent mindfulness sessions. Five participants had a session before and two after the transvaginal injection. One participant had two sessions: one before and one after separate injections. All six women completing a session prior to injection had at least moderate anxiety, which lessened after the mindfulness session (median NRS change: -3.3/10). All three women reporting injection-associated pain experienced less intense pain following the post-injection session (median NRS change: -3/10). Three women experiencing dysphoria improved after the session (median NRS change: -3/10). A brief, guided mindfulness session may lessen acute pain, anxiety, and dysphoria associated with office-based transvaginal BoNT injection.
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Affiliation(s)
- Jacqueline V. Aredo
- Rehabilitation Medicine Department, Intramural Research Program, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA; (J.V.A.); (V.T.P.)
- Department of Medicine, University of California, San Francisco, CA 94143, USA
| | - Hannah K. Tandon
- Rehabilitation Medicine Department, Intramural Research Program, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA; (J.V.A.); (V.T.P.)
- Department of Internal Medicine and Geriatrics, Oregon Health and Science University, Portland, OR 97239, USA
| | - Samin Panahi
- Department of Family Science, School of Public Health, University of Maryland, College Park, MD 20742, USA
| | - Vy T. Phan
- Rehabilitation Medicine Department, Intramural Research Program, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA; (J.V.A.); (V.T.P.)
- School of Medicine, Georgetown University, Washington, DC 20007, USA
| | - Rezvan Ameli
- NIMH Representative to the Clinical Center Pain and Palliative Care Service, National Institutes of Health, Bethesda, MD 20892, USA;
| | - Barbara I. Karp
- Office of the Clinical Director, Intramural Research Program, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA;
| | - Pamela Stratton
- Office of the Clinical Director, Intramural Research Program, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA;
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Emerson B, Reddy M, Reiter PL, Shoben AB, Klatt M, Chakraborty S, Katz ML. Mindfulness-based Interventions Across the Cancer Continuum in the United States: A Scoping Review. Am J Health Promot 2024; 38:560-575. [PMID: 38205783 DOI: 10.1177/08901171241227316] [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] [Indexed: 01/12/2024]
Abstract
OBJECTIVE To review mindfulness-based interventions (MBIs) tested in randomized controlled trials (RCT) across the cancer continuum. DATA SOURCE Articles identified in PubMed, CINAHL, Web of Science, PsycINFO, and Embase. STUDY INCLUSION AND EXCLUSION CRITERIA Two independent reviewers screened articles for: (1) topic relevance; (2) RCT study design; (3) mindfulness activity; (4) text availability; (5) country (United States); and (6) mindfulness as the primary intervention component. DATA EXTRACTION Twenty-eight RCTs met the inclusion criteria. Data was extracted on the following variables: publication year, population, study arms, cancer site, stage of cancer continuum, participant demographic characteristics, mindfulness definition, mindfulness measures, mindfulness delivery, and behavioral theory. DATA SYNTHESIS We used descriptive statistics and preliminary content analysis to characterize the data and identify emerging themes. RESULTS A definition of mindfulness was reported in 46% of studies and 43% measured mindfulness. Almost all MBIs were tested in survivorship (50%) or treatment (46%) stages of the cancer continuum. Breast cancer was the focus of 73% of cancer-site specific studies, and most participants were non-Hispanic white females. CONCLUSION The scoping review identified 5 themes: (1) inconsistency in defining mindfulness; (2) differences in measuring mindfulness; (3) underrepresentation of racial/ethnic minorities; (4) underrepresentation of males and cancer sites other than breast; and (5) the lack of behavioral theory in the design, implementation, and evaluation of the MBI.
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Affiliation(s)
- Brent Emerson
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Menaka Reddy
- School of Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Paul L Reiter
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH, USA
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Abigail B Shoben
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Maryanna Klatt
- Center for Integrative Health, Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Subhankar Chakraborty
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
- Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Mira L Katz
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH, USA
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
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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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Gaffney CD, Vertosick EA, Carlsson SV, Lin X, Wolchasty N, Hardbattle R, Vickers AJ, Ehdaie B. A brief mind-body intervention to reduce pain and anxiety during prostate needle biopsy: a clinically integrated randomized controlled trial with 2-staged consent. Urol Oncol 2023; 41:484.e1-484.e5. [PMID: 37977915 PMCID: PMC11249357 DOI: 10.1016/j.urolonc.2023.09.016] [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: 06/28/2023] [Accepted: 09/25/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES Many patients experience pain, anxiety, and discomfort with prostate biopsy, which may discourage enrollment in active surveillance programs or follow-up biopsy. Guided meditation can significantly reduce pain and anxiety during percutaneous biopsy. We sought to evaluate the effectiveness of a brief mind-body intervention on patient-reported outcomes after prostate biopsy. METHODS AND MATERIALS We performed a clinically-integrated randomized controlled trial of a brief mind-body intervention during biopsy compared to usual care at a single tertiary care center from 2018 to 2022. All patients offered transrectal ultrasound-guided prostate biopsy in the clinic with local anesthesia were eligible for enrollment. This clinically integrated trial was conducted simultaneously with a randomized controlled trial of 1-stage and 2-stage consent. The primary outcome was patient-reported pain, anxiety, discomfort, and tolerability on a visual-analog scale (0-10). A 15% improvement was prespecified as clinically relevant. We compared the proportion of men in each arm reporting a severe score (7-10) on any of the 4 scales using Fisher's exact test and then compared means for each scale separately using ANCOVA with randomization stratum (first vs. prior biopsy) as a covariate. RESULTS Of 263 eligible patients, 238 enrolled (119 per arm). One hundred seventy-two (72%) enrolled with 2-stage consent. A total of 37/94 (39%) and 38/102 (37%) patients randomized to usual care and intervention, respectively, reported severe scores in any of the 4 domains, a difference of 2.1% (95% confidence interval [CI] -13, 17%, P = 0.8). There was no evidence of a difference in mean postbiopsy anxiety (P = 0.3), discomfort (P = 0.09), pain (P = 0.4) or tolerability scores (P = 0.2). CONCLUSIONS A clinically meaningful benefit for this brief mind-body intervention during prostate biopsy is unlikely. Robust patient enrollment is feasible using 2-stage consent.
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Affiliation(s)
- Christopher D Gaffney
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Emily A Vertosick
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sigrid V Carlsson
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Urology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Xin Lin
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Natalie Wolchasty
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robin Hardbattle
- Department of Integrative Medicine, Memorial Sloan Kettering, New York, NY
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Behfar Ehdaie
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY.
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Bentley TGK, D’Andrea-Penna G, Rakic M, Arce N, LaFaille M, Berman R, Cooley K, Sprimont P. Breathing Practices for Stress and Anxiety Reduction: Conceptual Framework of Implementation Guidelines Based on a Systematic Review of the Published Literature. Brain Sci 2023; 13:1612. [PMID: 38137060 PMCID: PMC10741869 DOI: 10.3390/brainsci13121612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 12/24/2023] Open
Abstract
Anxiety and stress plague populations worldwide. Voluntary regulated breathing practices offer a tool to address this epidemic. We examined peer-reviewed published literature to understand effective approaches to and implementation of these practices. PubMed and ScienceDirect were searched to identify clinical trials evaluating isolated breathing-based interventions with psychometric stress/anxiety outcomes. Two independent reviewers conducted all screening and data extraction. Of 2904 unique articles, 731 abstracts, and 181 full texts screened, 58 met the inclusion criteria. Fifty-four of the studies' 72 interventions were effective. Components of effective and ineffective interventions were evaluated to develop a conceptual framework of factors associated with stress/anxiety reduction effectiveness. Effective breath practices avoided fast-only breath paces and sessions <5 min, while including human-guided training, multiple sessions, and long-term practice. Population, other breath paces, session duration ≥5 min, and group versus individual or at-home practices were not associated with effectiveness. Analysis of interventions that did not fit this framework revealed that extensive standing, interruptions, involuntary diaphragmatic obstruction, and inadequate training for highly technical practices may render otherwise promising interventions ineffective. Following this evidence-based framework can help maximize the stress/anxiety reduction benefits of breathing practices. Future research is warranted to further refine this easily accessible intervention for stress/anxiety relief.
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Affiliation(s)
- Tanya G. K. Bentley
- Health and Human Performance Foundation, Los Angeles, CA 90272, USA (R.B.); (K.C.)
| | - Gina D’Andrea-Penna
- Health and Human Performance Foundation, Los Angeles, CA 90272, USA (R.B.); (K.C.)
- Neurosciences Graduate Program, University of California San Diego, La Jolla, CA 92093, USA
| | - Marina Rakic
- Health and Human Performance Foundation, Los Angeles, CA 90272, USA (R.B.); (K.C.)
| | - Nick Arce
- Health and Human Performance Foundation, Los Angeles, CA 90272, USA (R.B.); (K.C.)
| | - Michelle LaFaille
- Health and Human Performance Foundation, Los Angeles, CA 90272, USA (R.B.); (K.C.)
| | - Rachel Berman
- Health and Human Performance Foundation, Los Angeles, CA 90272, USA (R.B.); (K.C.)
| | - Katie Cooley
- Health and Human Performance Foundation, Los Angeles, CA 90272, USA (R.B.); (K.C.)
| | - Preston Sprimont
- Health and Human Performance Foundation, Los Angeles, CA 90272, USA (R.B.); (K.C.)
- Department of Kinesiology, California State University Fullerton, Fullerton, CA 92831, USA
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Lopez G, Chaoul A, Warneke CL, Christie AJ, Powers-James C, Liu W, Narayanan S, Delgado-Guay M, Li Y, Bruera E, Cohen L. Self-administered Meditation Application Intervention for Cancer Patients With Psychosocial Distress: A Pilot Study. Integr Cancer Ther 2023; 22:15347354221148710. [PMID: 36680352 PMCID: PMC9893056 DOI: 10.1177/15347354221148710] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND We explored the use of a novel smart phone-based application (APP) for delivery and monitoring of meditation to treat mood symptoms experienced by cancer patients. METHODS We assessed the feasibility of using a meditation delivery and tracking APP over 2-weeks and its impact on cancer patients' self-reported anxiety and depression. Outpatients reporting depression and/or anxiety were recruited and randomized to the APP or waitlist control group. Assessments included an expectancy scale, exit survey, mood rating before and after each meditation, and the Edmonton Symptom Assessment Scale (ESAS-FS), Hospital Anxiety and Depression Scale (HADS), and Pittsburgh Sleep Quality Index (PSQI) at baseline and after 2-weeks. The primary aim was to assess feasibility; secondary aims included satisfaction with the APP, association between meditation frequency and length with self-reported symptoms, and change in symptom measures (symptoms, anxiety, depression, and sleep). RESULTS Our study included 35 participants (17 meditation group; 18 controls) who were primarily female (94%) with breast cancer (60%). The 61% enrollment rate and 71% adherence rate met pre-specified feasibility criteria. Most meditation group participants described the APP as "Useful" to "Very Useful" and would "Probably" or "Definitely" recommend its use. Mixed model analysis revealed a statistically significant association between meditation length (5, 10, or 15 minutes) and change in anxiety, with 15-minute sessions associated with greater reductions in anxiety. In the exit survey, more meditation group vs. control group participants reported improved focus, mood, and sleep. Study groups differed significantly by ESAS fatigue score change; the meditation group decreased a median of 1.5 pts (IQR 2.5) and the control group increased a median of 0.5 points (IQR 2). The meditation group, but not the control group, experienced statistically significant improvement in ESAS fatigue, depression, anxiety, appetite, and physical, psychological, and global distress. Change in PSQI and HADS anxiety and depression scores did not reveal any statistically significant between-group differences. CONCLUSIONS This pilot study demonstrated the feasibility and acceptability of a meditation APP for cancer patients. Meditation APP users reported improvement in several measures of symptom distress. Future studies should explore ways to enhance the APP's usability and clinical benefit.
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Affiliation(s)
- Gabriel Lopez
- The University of Texas MD Anderson Cancer, Houston, TX, USA,Gabriel Lopez, Department of Palliative, Rehabilitation, and Integrative Medicine; The University of Texas MD Anderson Cancer, Unit 1414, 1515 Holcombe Blvd., Houston, TX 77030, USA.
| | | | | | | | | | - Wenli Liu
- The University of Texas MD Anderson Cancer, Houston, TX, USA
| | | | | | - Yisheng Li
- The University of Texas MD Anderson Cancer, Houston, TX, USA
| | - Eduardo Bruera
- The University of Texas MD Anderson Cancer, Houston, TX, USA
| | - Lorenzo Cohen
- The University of Texas MD Anderson Cancer, Houston, TX, USA
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Silveira JD, Fausto DY, Saraiva PSDS, Boing L, Lyra VB, Bergmann A, Guimarães ACDA. How do Body Practices Affect the Psychological Aspects of Survivors Women Undergoing Treatment for Breast Cancer? Systematic Literature Review. REVISTA BRASILEIRA DE CANCEROLOGIA 2022. [DOI: 10.32635/2176-9745.rbc.2023v69n1.2981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introduction: Body practices can bring physical, psychological benefits and social rehabilitation and may be an alternative treatment for breast cancer. Objective: To analyze the evidence of the results of body practices over the psychological aspects of survivors women undergoing treatment for breast cancer. Method: Systematic blind and independent review from September to December 2021 following the PRISMA guidelines, carried out in the databases: Embase Elsevier; PubMed Central; ScienceDirect; Scopus Elsevier and Web of Science – Core Collection. Results: Of 1,372 studies identified, 22 were included in this systematic review. Among the practices that stood out are meditation and Yoga, with anxiety being the most investigated variable by the studies. It is clear that body practices are options for non-pharmacological clinical treatments utilized in clinical practice by different health professionals in women who have survived breast cancer. Conclusion: Body practices proved to be beneficial in the treatment and psychological health of women who survived breast cancer. This evidence may help to implement body practices as a therapeutic resource to be used in the clinical practice of health professionals. However, more randomized clinical trials that follow study protocols more rigorously are suggested, so that the effectiveness of this approach can be evaluated in different clinical outcomes.
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Mao JJ, Ismaila N, Bao T, Barton D, Ben-Arye E, Garland EL, Greenlee H, Leblanc T, Lee RT, Lopez AM, Loprinzi C, Lyman GH, MacLeod J, Master VA, Ramchandran K, Wagner LI, Walker EM, Bruner DW, Witt CM, Bruera E. Integrative Medicine for Pain Management in Oncology: Society for Integrative Oncology-ASCO Guideline. J Clin Oncol 2022; 40:3998-4024. [PMID: 36122322 DOI: 10.1200/jco.22.01357] [Citation(s) in RCA: 75] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The aim of this joint guideline is to provide evidence-based recommendations to practicing physicians and other health care providers on integrative approaches to managing pain in patients with cancer. METHODS The Society for Integrative Oncology and ASCO convened an expert panel of integrative oncology, medical oncology, radiation oncology, surgical oncology, palliative oncology, social sciences, mind-body medicine, nursing, and patient advocacy representatives. The literature search included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2021. Outcomes of interest included pain intensity, symptom relief, and adverse events. Expert panel members used this evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 227 relevant studies to inform the evidence base for this guideline. RECOMMENDATIONS Among adult patients, acupuncture should be recommended for aromatase inhibitor-related joint pain. Acupuncture or reflexology or acupressure may be recommended for general cancer pain or musculoskeletal pain. Hypnosis may be recommended to patients who experience procedural pain. Massage may be recommended to patients experiencing pain during palliative or hospice care. These recommendations are based on an intermediate level of evidence, benefit outweighing risk, and with moderate strength of recommendation. The quality of evidence for other mind-body interventions or natural products for pain is either low or inconclusive. There is insufficient or inconclusive evidence to make recommendations for pediatric patients. More research is needed to better characterize the role of integrative medicine interventions in the care of patients with cancer.Additional information is available at https://integrativeonc.org/practice-guidelines/guidelines and www.asco.org/survivorship-guidelines.
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Affiliation(s)
- Jun J Mao
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Ting Bao
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Debra Barton
- University of Michigan School of Nursing, Ann Arbor, MI
| | - Eran Ben-Arye
- Lin & Carmel Medical Centers, Clalit Health Services; Technion Faculty of Medicine, Haifa, Israel
| | - Eric L Garland
- College of Social Work, University of Utah, Salt Lake City, UT
| | | | | | - Richard T Lee
- City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Ana Maria Lopez
- Thomas Jefferson. Sidney Kimmel Cancer Center, Philadelphia, PA
| | | | - Gary H Lyman
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jodi MacLeod
- Patient Representative, Memorial Sloan Kettering Integrative Medicine Service, New York, NY
| | - Viraj A Master
- Winship Cancer Institute of Emory University, Atlanta, GA
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Mansor M, Chong MC, Chui PL, Hamdan M, Lim CC. Effect of mindfulness intervention on anxiety, distress, and depression for chronic diseases: a scoping review. PSYCHOL HEALTH MED 2022:1-13. [PMID: 36120729 DOI: 10.1080/13548506.2022.2124288] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
This scoping review describes the research-based mindfulness intervention on anxiety, distress, and depression. The search strategy retrieved articles published in English from 2014 to 2019 and were retrieved across Scopus, Web of Science, Science Direct, CINAHL, and Google Scholar. The PRISMA-Scr checklist is a tool to evaluate the quality of the articles. The selection criteria initially included all original articles in English, with 1,527 that were related to mindfulness intervention for anxiety, distress, and depression. A total of 490 full texts were retrieved, and after the abstracts were reviewed, 124 full-text articles were included for eligibility, and the final eight studies were determined. The articles were reviewed and screened for relevance to mindfulness intervention in reducing anxiety, distress, and depression among those with chronic diseases. The results have shown that mindfulness intervention reduces anxiety, distress, and depression among patients with chronic diseases. The review contributes further insight into the fact that mindfulness intervention is also appropriate for other conditions to facilitate reducing psychological symptoms.
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Affiliation(s)
- Mardiana Mansor
- Department of Nursing Science, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.,Department of Nursing, Faculty of Medicine, University Sultan Zainal Abidin, Terengganu, Malaysia
| | - Mei Chan Chong
- Department of Nursing Science, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Ping Lei Chui
- Department of Nursing Science, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Mukhri Hamdan
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Chin Choon Lim
- Faculty of Medicine, Widad University College, Kuantan, Malaysia
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11
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Brandel MG, Lin C, Hennel D, Khazen O, Pilitsis JG, Ben-Haim S. Mindfulness Meditation in the Treatment of Chronic Pain. Neurosurg Clin N Am 2022; 33:275-279. [PMID: 35718396 DOI: 10.1016/j.nec.2022.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Chronic pain is a leading cause of disability in the United States. Limited efficacy associated with pharmacologic management and surgical interventions in refractory patients has led to further exploration of cognitive and behavioral interventions as both an adjunctive and primary therapeutic modality. Mindfulness-based meditation has shown to be effective in reducing pain in randomized studies of chronic pain patients as well as models of experimentally induced pain in healthy participants. These studies have revealed specific neural mechanisms which may explain both short-term and sustained pain relief associated with mindfulness-based interventions.
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Affiliation(s)
- Michael G Brandel
- Department of Neurosurgery, University of California, 200 W. Arbor Drive #8893, USA
| | - Christine Lin
- Department of Neurosurgery, University of California, 200 W. Arbor Drive #8893, USA
| | - Devon Hennel
- Department of Neurscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Olga Khazen
- Department of Neurscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Julie G Pilitsis
- Department of Biomedical Research, Florida Atlantic University, Boca Raton, Florida, USA
| | - Sharona Ben-Haim
- Department of Neurosurgery, University of California, 200 W. Arbor Drive #8893, USA.
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12
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Kutay E, Milch H, Sayre J, Joines M, Hoyt A, Li B, Chan TL. Fear of the Unknown: The Benefits of a Patient Educational Handout on Breast Biopsy Markers. JOURNAL OF BREAST IMAGING 2022; 4:285-290. [PMID: 38416970 DOI: 10.1093/jbi/wbac016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Indexed: 03/01/2024]
Abstract
OBJECTIVE To determine whether providing a biopsy marker informational handout to patients improves patient knowledge and comfort with receiving a marker. METHODS In this IRB-exempt prospective study, a patient educational handout on breast biopsy markers was developed. A questionnaire was created with four questions asking patients to self-evaluate their knowledge of biopsy markers and their comfort level with marker placement before and after reading the handout. Technologists distributed the educational handouts to patients presenting for a percutaneous breast biopsy under any modality from December 11, 2020, to April 23, 2021. Data from the completed questionnaires were entered into a database. Statistical analyses included paired t-test and Wilcoxon analyses. RESULTS In total, 141 completed surveys were included in the analysis. The mean scores prior to reading the handout for knowledge and comfort were 2.59 and 3.40, respectively. After reading the handout, there was a significant increase in mean scores for knowledge and comfort (4.26 and 4.20, respectively) (P < 0.001). There was a 64% increase vs 23% increase for knowledge and comfort, respectively. CONCLUSION Patient-assessed knowledge of biopsy markers increased significantly after reading our educational handout. Patient-assessed comfort with biopsy marker placement also increased significantly after reading the educational handout, though to a lesser degree than knowledge. Although not included in our study, use of an educational handout may impact patient acceptance of marker placement. Future directions may include quantitatively assessing the effect of the handout on time to consent for a biopsy or influence on acceptance of marker placement.
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Affiliation(s)
- Erin Kutay
- University of California Los Angeles, Department of Radiology, Los Angeles, CA, USA
| | - Hannah Milch
- University of California Los Angeles, Department of Radiology, Los Angeles, CA, USA
| | - James Sayre
- University of California Los Angeles, Department of Radiological Sciences and Biostatistics, Los Angeles, CA, USA
| | - Melissa Joines
- University of California Los Angeles, Department of Radiology, Los Angeles, CA, USA
| | - Anne Hoyt
- University of California Los Angeles, Department of Radiology, Los Angeles, CA, USA
| | - Bo Li
- University of California Los Angeles, Department of Radiology, Los Angeles, CA, USA
| | - Tiffany L Chan
- University of California Los Angeles, Department of Radiology, Los Angeles, CA, USA
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13
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Rossini PG, Ostacoli L, Pagani M, Malandrone F, Oliva F, Cominu L, Annetta MC, Carletto S. The Neural Signature of Psychological Interventions in Persons With Cancer: A Scoping Review. Integr Cancer Ther 2022; 21:15347354221096808. [PMID: 35635127 PMCID: PMC9158410 DOI: 10.1177/15347354221096808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: People diagnosed with cancer have to deal with the debilitating psychological implications of this disease. Although the clinical efficacy of psychological interventions is well documented, relatively little has been written on the neural correlates of these treatments in the context of oncology. The present work is the first to provide an overall perspective of the existing literature on this topic. It also considers the potential directions for future research. Methods: This scoping review was carried out across 5 databases (EMBASE, PsycINFO, OVID MEDLINE, CINAHL, COCHRANE CENTRAL), from conception dates until 3 December 2021. Results: From an initial set of 4172 records, 13 papers were selected for this review. They consisted of 9 randomized controlled studies (RCTs), 1 quasi-experiment, 2 single case studies, and 1 secondary quantitative analysis. The studies were also heterogeneous in terms of the patient and control populations, psychological interventions, and neuroimaging methodologies used. The findings from these few studies suggest that psychological interventions in oncology patients may modulate both cortical and subcortical brain activity, consistent with the brain areas involved in distress reactions in general and to cancer specifically. The implications of this scoping review in terms of future research are also discussed. Conclusions: The literature on the neural correlates of psychological interventions in cancer patients is very limited, and thus requires further exploration. The provision of psychological interventions offers cancer patients a more integrated approach to care, which may in turn help preserve both the physical and the psychological wellbeing of individuals with cancer.
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Affiliation(s)
| | - Luca Ostacoli
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
- Clinical Psychology Unit, University Hospital “Città della Salute e della Scienza”, Turin, Italy
| | - Marco Pagani
- Institute of Cognitive Sciences and Technologies – CNR, Rome, Italy
| | - Francesca Malandrone
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Francesco Oliva
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Luca Cominu
- Clinical Psychology Unit, University Hospital “Città della Salute e della Scienza”, Turin, Italy
| | - Maria Chiara Annetta
- Clinical Psychology Unit, University Hospital “Città della Salute e della Scienza”, Turin, Italy
| | - Sara Carletto
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Turin, Italy
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14
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Srisopa P, Cong X, Russell B, Lucas R. The Role of Emotion Regulation in Pain Management Among Women From Labor to Three Months Postpartum: An Integrative Review. Pain Manag Nurs 2021; 22:783-790. [PMID: 34215526 DOI: 10.1016/j.pmn.2021.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 05/11/2021] [Accepted: 05/28/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Emotion regulation is a regulatory process to modify emotional activation in a wide range of situations and shows potential effects to reduce pain and emotional distress. The purpose of this review was to enhance an understanding of the role of emotion regulation strategies and their outcomes in reducing women's pain from labor to 3 months postpartum. DESIGN Integrative review. METHODS The literature was reviewed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The search was conducted using electronic databases CINAHL, PsycINFO, PubMed, Scopus, and ProQuest dissertation from 1990-2019. RESULTS Nine publications were included. Two emotion regulation strategies, mindfulness and distraction, were used. The findings revealed that prolonged training in mindfulness-based interventions produced significant improvements in decreasing pain intensity during labor and increasing maternal comfort 2 hours postpartum. The distraction strategy showed a significant decrease in pain intensity during labor for women who were trained and self-practiced during the prenatal period. CONCLUSIONS Both mindfulness and distraction would be offered to pregnant women as part of alternative self-pain management strategies to prepare them for dealing with pain and other discomforts. Future research needs to test the effects of the intervention beyond childbirth.
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Affiliation(s)
| | | | - Beth Russell
- Department of Human Development and Family Sciences, University of Connecticut, Mansfield, Connecticut
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15
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Shires A, Sharpe L, Davies JN, Newton-John TRO. The efficacy of mindfulness-based interventions in acute pain: a systematic review and meta-analysis. Pain 2020; 161:1698-1707. [PMID: 32701830 DOI: 10.1097/j.pain.0000000000001877] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Recent meta-analyses have shown mindfulness-based interventions (MBIs) to be effective for chronic pain, but no pooled estimates of the effect of MBIs on acute pain are available. This meta-analysis was conducted to fill that gap. A literature search was conducted in 4 databases. Articles were eligible if they reported on randomized controlled trials of MBIs for people with acute pain and one of the following outcomes: pain severity, pain threshold, pain tolerance, or pain-related distress. Two authors independently extracted the data, assessed risk of bias, and provided GRADE ratings. Twenty-two studies were included. There was no evidence of an effect of MBIs on the primary outcome of pain severity in clinical {Hedges' g = 0.52; (95% confidence interval [CI] -0.241 to 1.280)} or experimental settings (Hedges' g = 0.04; 95% CI [-0.161 to 0.247]). There was a beneficial effect of MBIs on pain tolerance (Hedges' g = 0.68; 95% CI [0.157-1.282]) and pain threshold (Hedges' g = 0.72; 95% CI [0.210-1.154]) in experimental studies. There was no evidence of an effect of MBIs compared to control for pain-related distress in clinical (Hedges' g = 0.16; 95% CI [-0.018 to 0.419]) or experimental settings (Hedges' g = 0.44; 95% CI [-0.164 to 0.419]). GRADE assessment indicated that except for pain tolerance, the data were of low or very low quality. There is moderate evidence that MBIs are efficacious in increasing pain tolerance and weak evidence for pain threshold. However, there is an absence of good-quality evidence for the efficacy of MBIs for reducing the pain severity or pain-related distress in either clinical or experimental settings.
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Affiliation(s)
- Alice Shires
- School of Psychology, University of Sydney, Sydney, NSW, Australia
- Graduate School of Health, University of Technology Sydney, New South Wales, Australia
| | - Louise Sharpe
- School of Psychology, University of Sydney, Sydney, NSW, Australia
| | | | - Toby R O Newton-John
- Graduate School of Health, University of Technology Sydney, New South Wales, Australia
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16
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Van Denburg AN, Shelby RA, Winger JG, Zhang L, Soo AE, Pearce MJ, Soo MS. Unmet Spiritual Care Needs in Women Undergoing Core Needle Breast Biopsy. JOURNAL OF BREAST IMAGING 2020; 2:134-140. [PMID: 38424885 DOI: 10.1093/jbi/wbz089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Spiritual care is an important part of healthcare, especially when patients face a possible diagnosis of a life-threatening disease. This study examined the extent to which women undergoing core-needle breast biopsy desired spiritual support and the degree to which women received the support they desired. METHODS Participants (N = 79) were women age 21 and older, who completed an ultrasound- or stereotactic-guided core-needle breast biopsy. Participants completed measures of spiritual needs and spiritual care. Medical and sociodemographic information were also collected. Independent sample t-tests and chi-square tests of examined differences based on demographic, medical, and biopsy-related variables. RESULTS Forty-eight participants (48/79; 60.8%) desired some degree of spiritual care during their breast biopsy, and 33 participants (33/78; 42.3%) wanted their healthcare team to address their spiritual needs. African American women were significantly more likely to desire some type of spiritual support compared to women who were not African American. Among the 79 participants, 16 (20.3%) reported a discrepancy between desired and received spiritual support. A significant association between discrepancies and biopsy results was found, χ 2(1) = 4.19, P = .04, such that 2 (7.4%) of 27 participants with results requiring surgery reported discrepancies, while 14 (26.9%) of 52 participants with a benign result reported discrepancies. CONCLUSION Most women undergoing core-needle breast biopsy desired some degree of spiritual care. Although most reported that their spiritual needs were addressed, a subset of women received less care than desired. Our results suggest that healthcare providers should be aware of patients' desires for spiritual support, particularly among those with benign results.
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Affiliation(s)
- Alyssa N Van Denburg
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC
| | - Rebecca A Shelby
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC
| | - Joseph G Winger
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC
| | - Lei Zhang
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC
| | - Adrianne E Soo
- Medical University of South Carolina College of Medicine, Department of Emergency Medicine, Charleston, SC
| | - Michelle J Pearce
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC
- University of Maryland, Baltimore, Center for Integrative Medicine, Baltimore, MD
| | - Mary Scott Soo
- Duke University School of Medicine, Department of Radiology, Durham, NC
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17
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Soo MS, Shelby RA, Johnson KS. Optimizing the Patient Experience during Breast Biopsy. JOURNAL OF BREAST IMAGING 2019; 1:131-138. [PMID: 38424912 DOI: 10.1093/jbi/wbz001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Indexed: 03/02/2024]
Abstract
For years, breast imaging has been the model in radiology for patient communication, and more recently, it has been a leader in the growing patient- and family-centered approach to care. To maintain high levels of patient satisfaction during image-guided core-needle breast biopsies, the radiologist should understand patient perspectives so that interventions can be developed to manage patient concerns. This article reviews patient perspectives before, during, and after imaging-guided breast biopsies, and it describes strategies to help optimize the experiences of patients as they navigate the process.
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Affiliation(s)
- Mary Scott Soo
- Duke University Medical Center, Department of Radiology, Durham, NC
| | - Rebecca A Shelby
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC
| | - Karen S Johnson
- Duke University Medical Center, Department of Radiology, Durham, NC
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