Coping with breast cancer: a phenomenological study

Psychometric properties of the Malay version of the Illness Cognition Questionnaire among cancer patients in Malaysia

OBJECTIVE

The Illness Cognition Questionnaire (ICQ) was translated from its original English version to the Malay version for this research, adapted the Malay language version of the ICQ (ICQ-M) for use in cancer patients, and assessed the internal consistency, content, face, construct, convergent, discriminant and concurrent validity of the ICQ-M among a cohort of cancer patients with mixed cancer types in Malaysia.

METHOD

Initially, the ICQ was translated into Malay and back-translated, and its content and face validity were evaluated. Then, 346 cancer patients with various cancer types received the ICQ-M, and its internal consistency, convergent, discriminant, construct, and concurrent validity were evaluated.

RESULTS

The ICQ-M and its domains had acceptable internal consistency with Cronbach's α ranging from 0.742 to 0.927. Construct validity assessment demonstrated that the ICQ-M consists of 17 items designated in two domains with good convergent and discriminant validity. The ICQ-M and its domains also had moderate correlations with the Acceptance and Action Questionnaire II, which denotes that the ICQ-M had acceptable concurrent validity.

CONCLUSION

The ICQ-M had good psychometric properties and is now available to measure the illness cognition of cancer patients in Malaysia.

Psychological experiences of family caregivers of patients with breast cancer: Protocol for a meta-synthesis

AIM

The number of breast cancer patients is increasing, but there are insufficient sources of information for their family caregivers. The purpose of this systematic review was to elaborate the psychologically realistic experiences and corresponding needs of family members of patients with breast cancer in the course of their experience in the disease which may provide them with effective, targeted intervention strategies to improve their quality of life.

DESIGN

Protocol for a meta-synthesis.

METHODS

We will search the Chinese databases (i.e., China National Knowledge Infrastructure, VIP Database and Wanfang Database) and the English databases (i.e., PubMed, Embase, Web of Science, the Cochrane Library, CINAHL and PsycINFO). Qualitative studies from the above databases, studying the psychological experiences of family members of patients with breast cancer, will be searched comprehensively. The quality of the study will be evaluated by two reviewers independently using the Joanna Briggs Institute (JBI) critical appraisal tools for qualitative study, and any disagreements will be discussed and judged by the third reviewer. Data will be extracted using JBI standardized data extraction tool. Then, the literature will be compared and analysed, and the raw results summarized using the JBI meta-aggregation tool. The reliability and credibility of the overall quality of the included studies will be assessed by using the JBI ConQual approach.

RESULTS

N/A. No Patient or Public Contribution.

PROSPERO REGISTRATION NUMBER

REDACTED.

Psychological Associations of Stress with the Level of Health Locus of Control and Self-Efficacy in Patients with Ovarian Cancer

The aim of this study was to analyze the locus of health control, self-efficacy and stress coping styles of female patients treated for ovarian cancer. Learning the styles of coping with stress in patients with ovarian cancer may contribute to improve their quality of life after cancer diagnosis. A series of Pearson's r-analyses was performed in the order to evaluate the hypotheses regarding the relationship between styles of coping with stress, the locus of health control and self-efficacy. A total of 151 female patients participated in this study. Standardized psychological questionnaires were used: the General Self-Efficacy Scale (GSES) to measure coping with difficult situations and obstacles, the Multi-Dimensional Health Locus of Control Scale (MHLC) to measure health control and the Convergence Insufficiency Symptom Survey (CISS) to measure stress coping styles. All questionnaires had an adaptation in Polish. Patients using task-focused and socializing styles had higher self-efficacy, whereas focusing on negative emotions resulted in lower self-efficacy. External locus of health control was related to a task-focused approach to treatment. On the other hand, the focus on negative emotions was related to the feeling that the fate of patients was decided by chance. Self-efficacy was positively associated with internal locus of health control and with external control, which means the influence of others. The results of our study indicate the need for a multidimensional approach to the treatment of female patients with ovarian cancer. The psychological condition of female patients has an ongoing relationship with their physical health.

Designing and validating an adaptation questionnaire among the husbands of Iranian Muslim women with breast cancer

Background

Breast cancer is the most common cancer among women and is the second leading cause of cancer death. This disease affects all aspects of the patient's life and family, especially the patient's spouse, which confirms the need to adapt to these changes. The common instruments used for the investigation of adaptation among husbands of women with breast cancer are mainly outdated, one-dimensional, or non-concordant with the Iranian culture. Therefore, the present study aimed to design and validate an adaptation scale among the husbands of Iranian Muslim women suffering from breast cancer.

Methods

This exploratory sequential mixed study was conducted in two qualitative and quantitative stages. In the qualitative stage, semi-structured interviews were performed with 21 participants. Then, items were developed through content analysis using the approach proposed by Elo and Kyngas on the basis of Roy's adaptation model. In the quantitative stage, the extracted items were reduced and psychometric properties such as face, content, and construct validity as well as reliability were explored. To investigate the construct validity, a cross-sectional descriptive study was conducted on 300 husbands of women with breast cancer selected via cluster sampling.

Results

The initial questionnaire contained 79 items. After the assessment of face and content validity, 59 items were evaluated regarding construct validity using exploratory factor analysis. At this stage, six adaptation dimensions were observed among the women's husbands, with the variance of 51.71. The Cronbach's alpha and correlation coefficient of the questionnaire were 0.912 and 0.701, respectively.

Conclusion

The developed 51-item adaptation scale had an appropriate validity and reliability and could be used for the assessment of adaptation in the target group.

Coping Strategies for Sexual Problems and Sexual Dysfunction Amongst Malay Women With Breast Cancer. A Qualitative Study

Introduction

Women’ sexuality becomes complex after breast cancer diagnosis and sexual health is highly neglected in the management of the illness.

Aims

To explore the coping and strategies to overcome sexuality problems and sexual dysfunction among women with breast cancer.

Material and Methods

Using the in-depth and photo-elicitation interview methods, this qualitative study following phenomenological analysis was conducted on fourteen married female respondents with breast cancer and had the positive result for female sexual dysfunction (FSD) screened by Female Sexual Function Index (FSFI-6 items) from Kelantan, Malaysia. The interviews data were audio-recorded, transcribed verbatim and managed in analytic computer software NVivo11 Pro. The transcriptions were analyzed using thematic analysis by referring to the meaning-making theory.

Main Outcome Measures

We identified overlapping themes of coping and strategies among women with breast cancer to overcome sexual problems and sexual dysfunction which correspond with meaning-making theory.

Results

Three themes have emerged. Women with breast cancer that developed sexuality problem and sexual dysfunction strived to accept the illness using religious belief and conform by altering sexual practices. These individuals positively look for a solution by seeking formal healthcare advice, modify their physical appearance, active discussion with the husband and support from other survivors. A few of them passively struggle with the subject by averting the intimacy and receptive toward polygamy.

Conclusion

This study highlighted the various mechanisms that emphasized the pivotal role of religious belief and relationship context as key factors in the coping strategies among women with breast cancer in Malaysia. The finding may not be generalized to other countries.

Che Ya SN, Muhamad R, Zain NM, et al. Coping Strategies for Sexual Problems and Sexual Dysfunction Amongst Malay Women With Breast Cancer. A Qualitative Study. Sex Med 2021;9:100336.

A scoping review of measures used to assess body image in women with breast cancer

OBJECTIVE

The emergence of body image studies in the oncology setting has led to the use of numerous measures to assess different dimensions of body image. The present study is a scoping review of the literature on body image in women with breast cancer to describe: measures used to assess body image in women with breast cancer, dimensions the measures used tap into, and gaps and issues needing attention going forward.

METHODS

Three databases were searched for peer-reviewed original studies that had: (1) full-texts available in English; (2) focused on women with breast cancer; and (3) assessed body image.

RESULTS

The search yielded 3,729 peer-reviewed articles; after screening, 562 articles met inclusion criteria. Of the 88 measures used, 28 were used in more than two studies and analyzed herein. The European Organization for Research and Treatment of Cancer Breast Cancer-Specific Quality of Life Questionnaire constituted the most frequently used measure. Most measures used focused on the affective dimension of body image (n = 24/28, 85.7%), followed by the cognitive (n = 20/28, 71.4%), behavioral (n = 13/28, 46.4%), and perceptual dimensions (n = 13/28, 46.4%).

CONCLUSIONS

This review provides a current summary of measures used to assess body image in women with breast cancer. Although some further development and refinement of body image measures could benefit the field, depending on the questions researchers or clinicians seek to answer, there are many available for use. Future research should use these measures to assess the effectiveness of interventions aimed at improving body image in women with breast cancer across the lifespan.

The Experiences and Support Needs of Women With Gestational Breast Cancer in Singapore: A Descriptive Qualitative Study

BACKGROUND

Gestational breast cancer is diagnosed during pregnancy or within the first postpartum year. There is a lack of studies on the experiences of ethnically diverse Asian women with gestational breast cancer.

OBJECTIVE

The aim of this study was to explore the experiences of Asian women with gestational breast cancer so necessary support can be rendered.

METHODS

This qualitative descriptive study used purposive sampling to recruit 7 women with gestational breast cancer who were following up at the breast center of a tertiary women's hospital in Singapore. Semistructured, individual, face-to-face, audio-recorded interviews were used to explore the in-depth experiences of these women. Data were transcribed verbatim and analyzed using thematic analysis.

RESULTS

Three main themes emerged from the thematic analysis: (1) being a sick woman, (2) juggling between being a mother and a patient, and (3) seeking normalcy. Women had to contend with disruptive changes from gestational breast cancer, both emotionally and physically. They were constantly distressed by their altered body images, and family support was vital to help these women cope with their treatments. Alternative support sources included healthcare professionals and the Internet.

CONCLUSION

Gestational breast cancer experiences varied based on the women's encounter perceptions and existing support. Their experiences may be improved through further support to mediate their coping efforts. Future quantitative and qualitative research should explore and evaluate the various aspects of the long-term disease and psychosocial effects of gestational breast cancer.

IMPLICATIONS FOR PRACTICE

Hospitals should include support strategies in antenatal classes and postnatal workshops to lessen disruptions of the motherhood experiences.

Lived experiences of women suffering from breast cancer in Kashmir: a phenomenological study

Using a phenomenological approach, this study aimed to gain an in-depth understanding of the lived experiences of Kashmiri women suffering from breast cancer within the context of their day-to-day lives. Snowball sampling and theoretical sampling techniques were employed for recruiting participants. Data collection was primarily based on the principles of data saturation. Data saturation occurred after 12 women with breast cancer were interviewed. Data was collected using face-to-face in-depth individual interviews. The interview guide consisted of open-ended questions. To attain the utmost variation, sumptuousness and profundity of responses, interviewer asked probing, specific, and interpreting questions during interviews. Data analysis of the transcripts was based on Graneheim and Lundman’s (Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Education Today 2004;24:105–12) procedures for taking out themes in qualitative data. Two main themes emerged that explained the lived experiences of women with breast cancer: (i) challenges encountered (altered body image, embarrassment, perceived worries, financial constraints, dealing with negative attitudes and stigma) and (ii) coping strategies (reliance on religion and spirituality, social support, living as usual, optimistic attitude and will to recover, and venting out). The findings revealed that breast cancer diagnosis influences women significantly as they acknowledged that it wasthe most traumatic experience of their life; however, with time, they started to accept the reality and made use of various methods to cope with their illness.

Psychometric Performance of the Arabic Versions of the Cancer Behavior Inventory-Brief and the Functional Assessment of Cancer Therapy-Breast

BACKGROUND

Valid and reliable instruments in Arabic are needed to measure self-efficacy and quality of life for Arabic patients with cancer.

OBJECTIVE

The aim of this study was to test the psychometric performance of the Cancer Behavior Inventory-Brief Arabic (CBI-BA), including participant understanding of items, and the Functional Assessment of Cancer Therapy-Breast Arabic (FACT-BA).

METHODS

Using a cross-sectional design, 438 cancer patients completed the CBI-BA, 30 of whom completed cognitive interviews. A subsample 167 women with breast cancer also completed the FACT-BA. Internal consistency evidence was assessed with Cronbach's α and construct validity with principal axis factoring.

RESULTS

Internal consistency estimates were acceptable for the total CBI-BA (α = .81) and FACT-BA (α = .88) scales. Exploratory factor analyses showed evidence of construct validity for the CBI-BA; 1 factor was derived, compared with four in the original English version. Cognitive interviews indicated satisfactory patient understanding of CBI-BA items. The Arabic version of the general FACT-General scale had 4 factors according to expectation.

CONCLUSION

The CBI-BA has adequate psychometric performance for the measurement of self-efficacy for coping with cancer in Arabic patients. The FACT-General Arabic has adequate evidence of reliability and validity for the measurement of quality of life in Arabic women with breast cancer.

IMPLICATIONS FOR PRACTICE

The availability of culturally sensitive and psychometrically sound instruments for Arabic patients diagnosed with cancer should be valuable for healthcare clinicians and researchers to assess self-efficacy for coping with cancer and quality of life.

Experiences of breast cancer in Arab countries. A thematic synthesis

BACKGROUND

Breast cancer is the most common cancer in women globally. Its negative effects on a woman's quality of life are related to the individual and socio-cultural factors. This review aimed to identify and synthesise the reported experiences and quality of life of women with breast cancer in Arab countries.

METHODS

PubMed, Embase, Web of Science, SCOPUS, PsychInfo, CINAHL, Allied and Complementary Medicine Database, and Index Medicus for the Eastern Mediterranean Region were searched for articles published from start to March 2019 using PRISMA guidelines. These searches were complimented by citation tracking and  hand searching of relevant journals. A thematic synthesis was carried out on the 'findings/results' sections from the identified papers.

RESULTS

Of 5228 records identified, 19 were included in the review which represented 401 women from 11 Arab countries. All used qualitative methods of data collection to produce rich descriptions of experiences. Thematic synthesis of the extracted data identified three major themes, Perceptions and reactions, Coping or enduring and Changing roles.

CONCLUSIONS

This review provides a rich description of the reported quality of life and experiences of women with breast cancer in Arab countries. These are influenced by the women's and society's views of cancer, the women's role in society and family, religious faith and the healthcare context and access to treatment choices and information.

Investigating the effect of Integrated Educational Program on the Quality of Life among Cancer Patients: A Clinical Trial Study

Background:

cancer is one of the most common causes of death around the world. The process of this disease and the resulting complications reduce the quality of life of cancer patients. Taking the necessary measures for improving the quality of life of these patients seems to be essential. This study was performed to investigate the effect of integrated educational program on the quality of life of cancer patients.

Methods:

in this clinical trial study, 64 patients hospitalized in the specialized cancer hospital affiliated with Ahvaz Jundishapur University of Medical Sciences, Iran, were selected according to the inclusion criteria. Then, through blocked randomization method, they were assigned into intervention and control groups. The intervention group received the necessary trainings over four 60-min sessions (one session per week). The data collection in this study included demographic questionnaire and quality-of-life questionnaire of cancer patients (QLQ-C30). The quality of life was examined before the training as well as one and two months after the training. The data were analyzed by SPSS 20. Independent t-test was used to compare the means of the life quality dimensions of the studied groups.

Results:

all of the functional dimensions [physical, role function, emotional, cognitive, social(P≤0.05)] and symptomatic [fatigue, nausea and vomiting, pain, dyspnea, sleep disorders, diminished appetite, constipation, and diarrhea (P≤0.05)] of the quality of life of the intervention group increased significantly one and two months after running the integrated educational program.

Conclusion:

integrated training causes improved symptoms and enhanced quality of life in cancer patients. Thus, it is recommended that integrated training be conducted alongside the routine care of cancer patients. This can improve the therapeutic outcomes, and also highlights the important role of nurses as well as nursing cares.

Diabetes fatalism and its emotional distress subscale are independent predictors of glycemic control among Lebanese patients with type 2 diabetes

Background: Achieving and sustaining optimal glycemic control in type 2 diabetes (T2DM) is difficult because of socio-cultural and psychosocial factors including diabetes fatalism. Diabetes fatalism is 'a complex psychological cycle characterized by perceptions of despair, hopelessness, and powerlessness'. Purpose: The purpose of this paper is to explore whether diabetes fatalism and other psychosocial and socio-cultural variables are correlates of glycemic control in Lebanese population with T2DM. Methods: A convenience sample of 280 adult participants with T2DM were recruited from a major hospital in greater Beirut-Lebanon area and from the community. Diabetes fatalism was assessed using the Arabic version of 12-item Diabetes Fatalism Scale. Multiple linear regression models were used to assess the relationship between HbA1c and psychosocial and socio-cultural characteristics including diabetes fatalism. Four models were run to examine the independent association between HbA1c and diabetes fatalism and to identify which of the 3 subscales (emotional distress, spiritual coping and perceived self-efficacy) were associated with HbA1c. Results: The mean age of the participants was 58.24(SD = 13.48) and the majority were females (53.76%), while 32.73% of the sample had diabetes for more than 10 years. Fully adjusted multiple linear regression models showed that higher scores on diabetes fatalism and the emotional distress subscale (P = 0.018) were significantly associated with higher HbA1c values. In addition, having diabetes for more than 11 years (P = 0.05) and a higher number of diabetes complications (P < 0.001) were associated with higher HbA1c levels. However, advanced age (P = 0.055), female gender (P = 0.003), and diabetes education (P = 0.011) were significantly associated with lower HbA1c levels. Conclusion: This is the first study in the Arab region that identifies diabetes fatalism as an independent predictor of glycemic control among Lebanese. Future studies should further investigate this construct to guide interventions that can address it for better diabetes outcomes.

Cancer Survivors' Experiences and Explanations of Postcancer Fatigue: An Analysis of Online Blogs

BACKGROUND

Postcancer fatigue (PCF) is a form of chronic fatigue that is very common and can persist for years among disease-free cancer survivors. Despite this, PCF remains underreported and often goes untreated.

OBJECTIVE

The aim of this study is to explore PCF from the perspective of cancer survivors via online blogs, with a focus on their experiences and personal explanations of PCF.

METHODS

An online search identified 15 recent blogs written by cancer survivors who specifically discussed their PCF. Thematic analysis was used to analyze blog content.

RESULTS

Bloggers explained PCF as a severe and unpredictable symptom in their lives. They identified anxiety, emotional trauma, and cancer side effects to be the key causal factors of their PCF. Coping strategies adopted by bloggers included diet, exercise, acceptance and reducing workload to manage their fatigue.

CONCLUSIONS

Online blogs are a rich source of qualitative data that can give unique insight into issues faced by cancer survivors. Bloggers' accounts confirmed that PCF is a complex issue that can be a significant source of frustration in their everyday lives. This study highlighted that bloggers with PCF appear to have some coping strategies and understanding of PCF, yet these are not always consistent with current medical and psychological knowledge.

IMPLICATIONS FOR PRACTICE

This study has demonstrated that blogs can offer valuable information to existing knowledge of cancer survivors' experiences and explanations of PCF. The findings may assist healthcare professionals with educating patients about PCF and with increasing the legitimacy, awareness, and understanding of PCF.

A Comparative Study on Perceived Stress, Coping, Quality of Life, and Hopelessness between Cancer Patients and Survivors

Background and Aim:

Cancer patients and survivors need to cope with many physical and emotional stressors. This cross-sectional study compared the perceived stress, coping, quality of life (QOL), and hopelessness between cancer patients and cancer survivors and examined the relationship of perceived stress with coping, QOL, and hopelessness in cancer patients and cancer survivors.

Materials and Methods:

Using a purposive sampling technique, this study was conducted in the Medical Oncology Department of a multi-specialty tertiary care teaching hospital between February and May 2018. Thirty participants (15 cancer patients and 15 cancer survivors) in the age range of 30–60 years took part in the study. Both groups were assessed by the following instruments: Perceived Stress Scale, Coping Checklist, Quality of Life-Cancer, and Beck Hopelessness Scale.

Results:

Cancer patients are using maladaptive coping strategies and experiencing psychological distress with reduced QOL than cancer survivors. Furthermore, hopelessness was positively correlated with QOL among cancer survivors.

Conclusions:

Cancer patients are found to be distressed and hopeless with significant reductions in their QOL.

The Experiences of Muslim Family Members of Critically Ill Patients During End-of-Life Care in Saudi Arabia: A Qualitative Phenomenological Study

The aim of this study was to identify the needs, beliefs, and practices of Muslim family members during the end-of-life care for a family member in the intensive care unit (ICU) in Saudi Arabia. This was a phenomenological study using in-depth individual interviews to gather data. Ten family members of adult ICU patients receiving end-of-life care were interviewed. The experiences of family members during end-of-life care were reflected in four major themes: (a) the spirituality of death, (b) family’s need for information, (c) being there, and (d) the ICU environment. Participants placed high value on religious practices such as prayer, and appreciated when these practices could be accommodated in the ICU. Family participants also detailed their need for frequent communication and opportunities to ask questions about the care of their critically ill loved one. Being able to spend as much time as desired in close proximity to the critically ill patient particularly as the end of life approaches was also important, with participants suggesting that visitation times should be waived. Finally, family participant suggested that changes were needed to the ICU environment to make accommodating large families easier and more comfortable particularly when they wish to spend significant time at the bedside of their loved one. Family should be prioritized as an extension of the care provided to critically ill ICU patients, particularly those approaching end of life. A model of care should be introduced to deliver supportive and holistic care during the end-of-life care journey, supported by appropriate education regarding family care at the end of life.

Predictors of Diabetes Fatalism Among Arabs: A Cross-Sectional Study of Lebanese Adults with Type 2 Diabetes

Fatalism is a grounded cultural belief that is common among Arabs and is known to hinder self-care in chronic diseases including diabetes (Nabolsi and Carson in Scand J Caring Sci 25(4):716-724, 2011). The purpose of this study is to identify predictors of diabetes fatalism in this population. Data on 280 Lebanese patients with type 2 diabetes (mean age 58.24 ± 13.48 years; mean HbA1c 7.90 ± 1.90%; 53.76% females) recruited from one hospital in greater Beirut, Lebanon, and from the community using snowballing technique were examined. Multiple linear regression was used to assess the independent association between diabetes fatalism and demographic and patient characteristics. Age (β = -.14, 95% CI -.27, -.002), BMI (β = .35, 95% CI .15; .54), level of education (β = -3.98, 95% CI -7.64; -.32) and number of diabetes problems (β = -5.03, 95% CI -9.89; -.18) were significantly associated with diabetes fatalism in the regression model. The combination of demographic and patient characteristics accounted for 14.5% of the variance in diabetes fatalism scores' change. Patients with type 2 diabetes who exhibited more fatalistic attitudes were younger, of lower education levels, had higher BMI and had fewer diabetes comorbidities. Such findings are crucial for healthcare practitioners to identify fatalistic patients and to tailor culturally appropriate strategies in diabetes management. Further studies are warranted to explore other potential determinants of diabetes fatalism with larger sample and non-Lebanese Arabic population.

Depression and religiosity and their correlates in Lebanese breast cancer patients

BACKGROUND

Breast cancer bears considerable morbidity and mortality and is well known to increase the risk of major depression, whereas religiosity has been reported to be protective. We searched for an association between depression and religiosity in breast cancer patients. We also sought to find an association between depression and various sociodemographic and disease variables.

METHODS

One hundred two patients were interviewed. Sociodemographic, cancer profile, and religiosity questionnaires were administered. We screened for depressive disorders by using the Mini-International Neuropsychiatric Interview and the Beck Depression Inventory.

RESULTS

Most of our participants (n = 79; 77.4%) had high religiosity score. The prevalences of lifetime major depression, current major depression, and major depression after cancer diagnosis were 50.9%, 30.1%, and 43.1%, respectively. We could not find a correlation between religiosity and current depression, while the association with depression after cancer diagnosis was close to but did not reach statistical significance (P = .055) and in favor of a deleterious role of religiosity. Depression was only linked to marital status and insurance coverage. No association was found with disease-related variables.

CONCLUSIONS

Religiosity does not seem to be protective against depression development. The stress of cancer appears to be the main culprit in increasing the risk of depression.

Nothing is more important than my partner's health: Turkish men's perspectives on partner's appearance after mastectomy and alopecia

PURPOSES

The aim of this study was to acquire a deeper understanding of male experiences on the emotional and social impact of their partners' mastectomy and chemotherapy-induced alopecia.

METHODS

A purposive sample of 16 males whose partners had undergone mastectomy and alopecia due to chemotherapy was chosen. The data were collected through a semi-structured interview method. Interpretative Phenomenological Analysis of tape-recorded interviews was employed.

RESULTS

Two main themes emerged from the data: facing the changes and my wife and I at present. Male partners were affected differently by the change in the physical appearance of their female partners. Our study participants said it was a difficult experience to see their partners for the first time after the surgery, but they emphasized that it was more important that their partners were healthy than the fact that they did not have a breast and hair. They also said they did not know how to behave towards their partners after surgery and/or chemotherapy. Nevertheless, they felt that the disease process of their partners had strengthened their bond and had not negatively influenced their relationship with others.

CONCLUSIONS

The changes in the partners' physical appearance after mastectomy and chemotherapy affected males differently in psychological, emotional and social terms. Since nurses working in this field are in contact with patients during all phases of treatment and care, it would be positive and beneficial to plan nursing interventions that give emotional support for male partners of patients with breast cancer.

From a Death Sentence to a Disrupted Life: Palestinian Women's Experiences and Coping With Breast Cancer

This study explores women's experiences of breast cancer in the occupied Palestinian territory. We use an inductive qualitative design with a thematic analytical approach for conducting and analyzing 35 semi-structured interviews with breast cancer patients. The interviews focused on diagnosis, experiences and coping with breast cancer, social support and care needs, and the impact of illness on their families and social relationships. Three themes emerged: (a) the transition from initial shock to the daily struggles with disruptions caused by illness, (b) the role of social support in helping women cope with the burden of disease, and the importance of (c) faith and reliance on God (tawakkul). In the Palestinian context, women's narratives highlighted the disruptive nature of breast cancer. Our findings underline the importance of social support provided by extended family members. Finally, faith is an important overarching theme that influences how women make sense of and cope with breast cancer.

Facilitating and hindering factors for coping with the experience of having a child with cancer: A Lebanese perspective

BACKGROUND

Families with a child with cancer face significant emotional and psychosocial stressors. The frequency of childhood cancer is increasing in Lebanon with more than 282 children diagnosed each year. This condition is reported to evoke a range of challenging emotions for parents, yet no studies have been conducted on the facilitating and hindering factors that affect Lebanese parents coping with a child with cancer.

OBJECTIVES

The purpose of the study was to gain an in-depth understanding of factors facilitating and hindering coping methods of Lebanese parents with a child with cancer.

METHODS

The study followed purposeful sampling and saturation principles in which 12 parents (mother or father) of a child were interviewed. Data were analyzed following the Utrecht School of phenomenology.

RESULTS

Helpful and harmful experiences emerged through the coding process. The enabling factors were social/family support; talking about it; strong religious beliefs; and the communication style of health workers. On the other hand, the deterring factors were the waiting time and the hospital stay; changes in the couple's relationship; and sibling rivalry.

CONCLUSION

These results could be used as the basis for additional research aimed at developing a structured approach to care that endorses the coping processes of Lebanese parents with a child with cancer.

IMPLICATIONS FOR CLINICAL PRACTICE

Nursing and medical staff need to be conscious of parents' coping strategies and their impact on family dynamics and the relationship between the family and the health care team.

Body Image of Women with Breast Cancer After Mastectomy: A Qualitative Research

OBJECTIVE

To gain a holistic and deep understanding about how mastectomy effects the body image of women who have breast cancer.

MATERIALS AND METHODS

The sample of this qualitative descriptive study consisted of twenty patients who underwent mastectomy procedures. Semi-structured interviews were conducted during the second week after mastectomy. Each interview was transcribed verbatim, and a thematic analysis was performed.

RESULTS

After the mastectomy, the findings related to the women's body image and their experiences were specified as four main themes and seven sub-themes. The main themes were: meaning of the breast, mastectomy and me, my body image and body image changes, and social life. Most of the participants in this study stated that the breast meant femininity, beauty, and motherhood. It was found that the meaning of mastectomy varied according to individuals. Women used quite negative statements about their appearances. The participants also said that they felt that half themselves was missing, as individuals and women. The women stated that they preferred clothes that hid their lack of breast. Some of the participants mentioned that relations with their husbands were not like before, and they abstained from social interaction.

CONCLUSION

Our findings suggest that mastectomy as a surgical treatment for breast cancer may negatively affect a woman's body image and her self-image.

Lived experiences of breast cancer survivors after diagnosis, treatment and beyond: qualitative study

BACKGROUND

The number of breast cancer survivors has increased since 1990 due to advances in biomedical technology that lead to an increase in early diagnosis and treatment. Research on survivorship has focused on the psychological and treatment aspects of the disease. The goal of this study was focused on exploring the lived experiences of breast cancer survivors from diagnosis, treatment and beyond.

OBJECTIVE

To understand the lived experiences of women who are breast cancer survivors.

DESIGN, SETTING AND PARTICIPANTS

A purposive sampling strategy was used to recruit participants from two Missouri cancer centres. A total of 15 women breast cancer survivors were interviewed.

FINDINGS

Three major themes emerged that described the lived experiences of the women. These were factors from the diagnosis and treatment management impacting survivorship, relationship and support system and implication of survivorship. Participants noted that coping with the diagnosis and treatment was a stressful journey and required lots of adjustment and changes. Some developed various techniques such as journaling their activities which provided comfort. In addition, support from family was shared as the key which gave them strength and courage through the different stages of treatment. However, they found it difficult to articulate what survivorship meant.

CONCLUSION

Using in-depth interview techniques, this study shed light on the experiences of women who were diagnosed with breast cancer and have completed treatment. They acknowledged frustration with their diagnosis and body changes. Support received from family and friends helped them cope through their treatment. However, they felt abandoned once the treatment phase was over and were uncertain what survivorhood meant to them.

Revealing a cancer diagnosis to patients: attitudes of patients, families, friends, nurses, and physicians in Lebanon-results of a cross-sectional study

BACKGROUND

Disclosure of a cancer diagnosis to patients is a major problem for physicians in Lebanon. Our survey aimed to identify the attitudes of patients, families and friends, nurses, and physicians regarding disclosure of a cancer diagnosis.

METHODS

Study participants included 343 physicians, nurses, cancer patients, families, and friends from clinics in two major hospitals in Lebanon. All completed a 29-item questionnaire that assessed, by demographic group, the information provided about cancer, opinions about the disclosure of the diagnosis to cancer patients, perceived consequences to patients, and the roles of family, friends, and religion.

RESULTS

Overall, 7.8% of the patients were convinced that cancer is incurable. Nearly 82% preferred to be informed about their diagnosis. Similarly, 83% of physicians were in favour of disclosing a cancer diagnosis to their patients. However, only 14% of the physicians said that they revealed the truth to the patients themselves, with only 9% doing so immediately after confirmation of the diagnosis. Disclosure of a cancer diagnosis was preferred before the start of the treatment by 59% of the patients and immediately after confirmation of the diagnosis by 72% of the physicians. Overall, 86% of physicians, 51% of nurses, and 69% of patients and their families believed that religion helped with the acceptance of a cancer diagnosis. A role for family in accepting the diagnosis was reported by 74% of the patients, 56% of the nurses, and 88% of the physicians. All participants considered that fear was the most difficult feeling (63%) experienced by cancer patients, followed by pain (29%), pity (8%), and death (1%), with no statistically significant difference between the answers given by the participant groups.

CONCLUSIONS

The social background in Lebanese society is the main obstacle to revealing the truth to cancer patients. Lebanese patients seem to prefer direct communication of the truth, but families take the opposite approach. Physicians also prefer to communicate the reality of the disease at the time of diagnosis, but in actuality, they instead disclose it progressively during treatment. Faith is helpful for acceptance of the diagnosis, and families play a key role in the support of the patients. An open discussion involving all members of society is necessary to attain a better understanding of this issue and to promote timely disclosure of a cancer diagnosis.

Controlling fear: Jordanian women's perceptions of the diagnosis and surgical treatment of early-stage breast cancer

BACKGROUND

Despite the fact that breast cancer is the most prevalent cancer among Jordanian women, practically nothing is known about their perceptions of early-stage breast cancer and surgical treatment.

OBJECTIVE

The objective of this study was to gain understanding of the diagnosis and surgical treatment experience of Jordanian women with a diagnosis of early-stage breast cancer.

METHODS

An interpretive phenomenological approach was used for this study. A purposive sample of 28 Jordanian women who were surgically treated for early-stage breast cancer within 6 months of the interview was recruited. Data were collected using individual interviews and analyzed using Heideggerian hermeneutical methodology.

RESULTS

Fear had a profound effect on Jordanian women's stories of diagnosis and surgical treatment of early-stage breast cancer. Women's experience with breast cancer and its treatment was shaped by their preexisting fear of breast cancer, the disparity in the quality of care at various healthcare institutions, and sociodemographic factors (eg, education, age).

CONCLUSIONS

Early after the diagnosis, fear was very strong, and women lost perspective of the fact that this disease was treatable and potentially curable. To control their fears, women unconditionally trusted God, the healthcare system, surgeons, family, friends, and/or neighbors and often accepted treatment offered by their surgeons without questioning.

IMPLICATIONS FOR PRACTICE

Jordanian healthcare providers have a responsibility to listen to their patients, explore meanings they ascribe to their illness, and provide women with proper education and the support necessary to help them cope with their illness.

Coping strategies in egyptian ladies with breast cancer

INTRODUCTION

A diagnosis of breast cancer regardless of the stage can be stressful, impact multiple spheres of life, and disrupt physical status, emotional and spiritual well-being, and personal relationships for the patient and family. In order to adapt, the patient ought to employ certain coping mechanisms. Individuals with terminal illness who utilize coping strategies have better quality of life compared to those who do not.

PATIENTS AND METHODS

This study aimed to determine the strategies used by females with breast cancer to cope with such stress by using Brief COPE scale and the hospital anxiety and depression scale. The study included 56 female patients diagnosed with operable breast cancer at Mansoura Oncology Center before surgery.

RESULTS

Large proportion of patients used acceptance, religion, and emotional support in coping with the stress of having breast cancer. Patients with depressive symptoms scored significantly higher venting while those with anxiety scored higher positive reframing, planning, and venting.

CONCLUSION

Efforts should be made to encourage women with breast cancer to use coping strategies that have been found to be helpful (eg, acceptance, emotional support, distraction, and active coping strategies).

Understanding the breast cancer experience: a qualitative study of Malaysian women

Breast cancer is the most common and leading cause of cancer mortality among Malaysian women. Despite good survival rates, the diagnosis of cancer still invokes the feeling of stress, fear and uncertainty. Because very little is known about the experiences of Malaysian women with breast cancer, a qualitative study using semi- structured interviews to explore the lived experience of newly diagnosed breast cancer. Using a purposive sampling method, 20 Malaysian women newly diagnosed with breast cancer, including Malays (n=10) and Chinese (n=10) were recruited in two main public hospitals in Kelantan. Similarities and divergence in women's experience were identified through thematic analysis of interview transcripts. Three themes emerged from the data: uncertainty experience of the illness, transition process and fatalistic view of breast cancer. In many ways, these findings were parallel with previous studies, suggesting that the experience of breast cancer is to a certain extent similar among women newly diagnosed with breast cancer. This study adds to the sparse literature concerning the experience of illness following breast cancer diagnosis among the Malays and Chinese. More importantly, this study addressed areas that were previously lacking, specifically in depth information on breast cancer experience from a developing country with a multi-ethnic population. The results of this investigation provide preliminary information to healthcare professionals on the impact of illness and cultural influence on survivorship to plan for appropriate education and supportive programme in order to meet the needs of breast cancer women more effectively.

The Phantom of Death Improving Quality of Life

The purpose of this study was, using secondary analysis on data collected from previous empirical studies, to focus on improving the quality of life due to the new possibilities for living after a cancer diagnosis. No matter how long or short the life will be, quality of life in palliative care is about “living in the best way” until death. The data analysis identified 4 main themes; death as a main concern, reevaluating life, living a normal life with support, and living until death. The key message is that the patients are living until they die. Palliative care should facilitate and support the patients in their new life situation in order to sustain their quality of life. They are still alive—living until death.

Stigma, perceived blame, self-blame, and depressive symptoms in men with colorectal cancer

BACKGROUND

We measured the prevalence of stigma, self-blame, and perceived blame from others for their illness among men with colorectal cancer (CRC) and examined whether these factors were associated with depressive symptoms, independent of clinical and sociodemographic factors.

METHODS

Self-administered questionnaires were returned in the fall of 2009 by 1109 eligible male US veterans who were diagnosed with CRC at any Veterans Affairs facility in 2008. Questionnaires assessed stigma, feelings of blame, and depressive symptoms as well as other facets of health, cancer characteristics, and quality and type of medical care. We report the prevalence of cancer stigma, self-blame, and perceived blame from others. We used multivariate linear regression to assess the association between these factors and a measure of depressive symptoms. Covariates included several measures of overall health, cancer progression, symptom severity, and sociodemographic factors.

RESULTS

Thirty one percent of respondents endorsed at least one item in a measure of cancer stigma and 25% reported feeling that it was at least 'a little true' that they were to blame for their illness. All three independent variables were associated with depressive symptoms in bivariate models; cancer stigma and self-blame were significantly associated with depressive symptoms in the multivariate model.

CONCLUSIONS

Cancer stigma and self-blame are problems for a significant minority of men with CRC and are independent predictors of depressive symptoms. They may represent an important source of stress in men with CRC.