Exploring Women's Experiences of TRAM Flap Breast Reconstruction After Mastectomy for Breast Cancer

Chinese medical staff's knowledge, attitudes and practices towards breast cancer patients' sexual health management: A cross-sectional study

Objective

The objective of this research was to assess the level and determinants of medical personnel's knowledge, attitudes, and practices regarding the management of sexual health in breast cancer survivors residing in western China.

Background

Sexual well-being is a crucial aspect of one's overall satisfaction with life. Once female sexual dysfunction (FSD) occurs, it will affect patients' satisfaction and life quality seriously. In all healthcare settings, the management of sexual health relies heavily on the vital contribution of medical personnel. Nevertheless, the sexual requirements of individuals with breast cancer are still partially unmet.

Design

A web-based questionnaire was used to conduct a multi-centered, cross-sectional study involving medical staff from 26 hospitals in nine cities of Guizhou Province, China.

Methods

Data was gathered from healthcare professionals using a validated tool, the knowledge, attitudes, practices assessment scale for managing the sexual health of breast cancer patients in medical staff. This tool was used to evaluate the knowledge, attitudes, and practices of medical staff regarding sexual health management.

Results

In this study, a grand total of 3181 healthcare professionals took part. The overall KAP scores, including knowledge, attitudes, and practices, were 47.15 ± 11.91, 72.55 ± 12.56, and 58.61 ± 11.45, respectively. Three variables exhibited a strong and favorable correlation. The study identified significant concerns regarding the limited understanding of medical personnel regarding effective strategies for enhancing sexual health function in breast cancer patients, as well as their diminished confidence in addressing FSD. The scores of knowledge, attitudes, and practices related to sexual health management were significantly influenced by whether or not training was received.

Conclusions

The study results emphasize the importance of adopting a holistic approach to enhance the understanding, perspectives, and behaviors of healthcare professionals regarding the management of sexual health. In addition to enhancing the standard of care for individuals with breast cancer.

Body image experience of women with breast cancer: A meta-synthesis

BACKGROUND

Body image is a multidimensional concept that involves the mental image of the human body and the feeling of being oneself throughout existence. Treatment for breast cancer causes several bodily changes that affect women's body image.

AIMS

This meta-synthesis aims to synthesise and interpret primary qualitative studies on the experience of body image in women undergoing treatment for breast cancer.

METHODS

A qualitative meta-synthesis was conducted employing systematic searches in six databases (PubMed, CINAHL, SCOPUS, Web of Science, PsycINFO, and LILACS). Data analysis was performed according to thematic synthesis.

RESULTS

Forty studies were included. Five descriptive themes were identified: (1) actively saying goodbye to body image; (2) the rupture of body image; (3) the sacrifice of body image in exchange for life; (4) body image as a vehicle for social expression; and (5) resignation of the alterated body image. These themes were understood through one analytical theme: Half-woman: body image of the woman with breast cancer.

CONCLUSION

The experience of body image in the context of breast cancer is a dynamic phenomenon, which involves dismissal, rupture, and resignation and occurs mediated by interpersonal contact.

Body acceptance in women with breast cancer: A concept analysis using a hybrid model

BACKGROUND

Women with breast cancer undergo drastic physical changes which can impact their body image. Accepting the altered body has recently been highlighted as the key to body image improvement, however, there is no clear definition or conceptualization of it. This study clarified the concept of body acceptance in women with breast cancer, using a hybrid model.

METHODS

In the theoretical phase, the attributes and working definitions of the concept were identified through an extensive literature review. Individual in-depth interviews were conducted during the fieldwork phase to elucidate the concept and verify the attributes derived from the theoretical phase. Finally, in the final analytic phase, the findings were compared and integrated.

RESULTS

The theoretical and fieldwork phases included 20 out of the 579 articles extracted from the literature search and five women who had undergone breast cancer surgery, respectively. Body acceptance was defined as "acknowledging, normalizing, and overcoming changes in body appearance and function caused by breast cancer and its treatment".

CONCLUSIONS

Body acceptance has been identified as a key factor directly related to the overall quality of life. This study provides a theoretical basis for developing effective interventions and consequently facilitates their provision in practice.

Patient experience of implant loss after immediate breast reconstruction: An interpretative phenomenological analysis

Immediate breast reconstruction (IBR) is an integral part of modern breast cancer treatment. Our aim was to investigate patient experience with implant loss after IBR by using interpretative phenomenological analysis (IPA). We conducted semi-structured interviews with eight informants. We analyzed data according to the IPA flexible seven-stage process and four main themes were developed: immediate breast reconstruction as the indisputable choice, a difficult experience, an altered body: redefining normality, and trying to cope. The experience of implant loss appears to affect women for many years and might overshadow some of the benefits of IBR.

"My Husband Affects Me More Than My Cancer": Reflections on Simultaneous Intimate Partner Violence and Breast Cancer Experience in a 48-Year-Old Woman

In this paper, we present the case of a 48-year-old woman diagnosed with early breast cancer. As candidate for mastectomy, she refused immediate reconstruction. She was referred to a psycho-oncologist for further evaluation and support. Psychological sessions helped reveal a history of intimate partner violence and helped clarify the reason for her refusal to undergo immediate reconstruction. Experience with this case highlights the importance of a multidisciplinary practice in which collaboration between surgeons, oncologists, and mental health professionals leads to a more in-depth understanding of the apparently paradoxical behaviors of patients, and to better care for their needs.

Patient Information Needs and Breast Reconstruction After Mastectomy: A Qualitative Meta-Synthesis

Background

Although many women benefit from breast reconstruction after mastectomy, several studies report women's dissatisfaction with the level of information they were provided with before reconstruction.

Objective

The present meta-synthesis examines the qualitative literature that explores women's experiences of breast reconstruction after mastectomy and highlights women's healthcare information needs.

Methods

After a comprehensive search of 6 electronic databases (CINAHL, Cochrane Library, EMBASE, MEDLINE, PsycINFO, and Scopus), we followed the methodology for synthesizing qualitative research. The search produced 423 studies, which were assessed against 5 inclusion criteria. A meta-synthesis methodology was used to analyze the data through taxonomic classification and constant targeted comparison.

Results

Some 17 studies met the inclusion criteria, and findings from 16 studies were synthesized. The role of the healthcare practitioner is noted as a major influence on women's expectations, and in some instances, women did not feel adequately informed about the outcomes of surgery and the recovery process. In general, women's desire for normality and effective emotional coping shapes their information needs.

Conclusion

The information needs of women are better understood after considering women's actual experiences with breast reconstruction. It is important to inform women of the immediate outcomes of reconstruction surgery and the recovery process.

Implications for Practice

In an attempt to better address women's information needs, healthcare practitioners should discover women's initial expectations of reconstruction as a starting point in the consultation. In addition, the research revealed the importance of the nurse navigator in terms of assisting women through the recovery process.

Exploring Women's Support Needs After Breast Reconstruction Surgery: A Qualitative Study

BACKGROUND

The procedures for breast reconstruction (BR) after mastectomy frequently initiate a difficult recovery period. A better understanding of women's support needs after surgery would improve patient care.

OBJECTIVE

The aim of this study was to identify patients' support needs after BR.

METHODS

In a retrospective study design, 21 participants described their support experiences after BR, including their sources of support and the impact of support on their recovery in a semistructured interview. Transcriptions of the interviews were analyzed using thematic analysis.

RESULTS

Four support needs were identified and were composed of elements of instrumental, emotional, and informational support. These needs were addressed to varying degrees by healthcare providers, family members, and other women who had BR experience.

CONCLUSION

Women's experience of BR and their ability to cope are markedly better when their support needs are effectively addressed. Greater attention to their needs for support has the potential to improve patient care.

IMPLICATIONS FOR PRACTICE

Nurses play a pivotal role in providing information to women who are recovering from BR. Improved access to communication channels between nurses and patients would likely improve patients' support experiences. In addition, nurses can assess the women's specific support needs and partner with families to help them understand how best to support women during recovery.

Quality of life and personal resilience in the first two years after breast cancer diagnosis: systematic integrative review

The aim of this systematic integrative review was to examine the early impacts of a breast cancer diagnosis (up to 2 years after diagnosis) in relation to quality of life and personal resilience. The bibliographic databases of Medline, CINAHL, Cochrane, and Psychology and Behavioral Science Collection were searched using predetermined search criteria. Research studies published up to February 2019 were considered and following appraisal 36 articles were included in the review. Younger age, disease progression at first presentation, personality factors such as optimism, and moderators such as social support, clinical interventions and development of self-management abilities predicted better quality of life and personal resilience. Not recovering from the physical and psychological impacts of a new diagnosis has implications for future mental and physical health. This systematic, integrative review highlighted that building resilience and working with women's strengths should be the focus for contemporary clinical interventions for women in the early period after diagnosis of breast cancer.

'It's a silver lining': A template analysis of satisfaction and quality of life following post-mastectomy breast reconstruction

OBJECTIVE

In the United Kingdom, the number of women undergoing post-mastectomy breast reconstruction is increasing. Consequently, exploring patient-reported outcomes in breast surgery has become increasingly important. This study investigated satisfaction and quality of life following post-mastectomy breast reconstruction.

DESIGN

Qualitative research design.

METHODS

In-depth, semi-structured telephone interviews were conducted with 25 women (age, M = 53.08, SD = 8.41) following breast reconstruction in the United Kingdom. Data were analysed using template analysis which produced three-first-level, 13 second-level, and 19 third-level themes.

RESULTS

Following reconstruction, women reported improved emotional functioning, although this was often accompanied by deterioration in physical, sexual, and/or social functioning. Women positively appraised their breast appearance, although some reported a decline in satisfaction over time, attributing this decline to their chosen reconstructive technique. Many women accepted the inevitability of scarring and most perceived their scars as a representation of their journey, signifying survival. Generally, women were satisfied with the outcome of their reconstruction, although on reflection some would not have opted for reconstruction. Following breast reconstruction, women were increasingly likely to experience the fear of recurrence, attributed to no longer being able to have a mammogram on the affected breast(s).

CONCLUSIONS

This study provides new insights into post-mastectomy breast reconstruction and is a novel application of template analysis. The analysis demonstrates only slight variation in some categories of experience among women, despite a heterogeneous sample. The findings allow researchers and clinicians to focus on specific dimensions of satisfaction and quality of life to support the needs of women following reconstruction. Statement of contribution What is already known on this subject? Patient satisfaction and quality of life are key patient-reported outcomes of breast reconstruction, although relatively few studies distinguish between types of satisfaction. The number of women electing to undergo reconstructive surgery is steadily increasing. As a consequence, exploring patient-reported outcomes in reconstructive breast surgery has become increasingly important for research and clinical practice. It is often suggested that breast reconstruction offers psychosocial benefits, although within the literature some mixed findings have been reported. Therefore, a qualitative exploration has the potential to add some clarity to the experiences of women following post-mastectomy breast reconstruction. What does this study add? To our knowledge, this is the first study to employ template analysis to explore the experiences of women following post-mastectomy breast reconstruction. Template analysis demonstrated that there was only slight variation in some categories of experience among women, despite a heterogeneous sample. This study distinguishes between the patient-reported outcomes breast satisfaction and outcome satisfaction to identify the key factors that are involved in determining satisfaction. The findings allow researchers and clinicians to focus on specific dimensions of satisfaction and quality of life which require improvement to support the unmet needs of women following breast reconstruction. The study presents two novel findings. Women attributed the fear of cancer recurrence to no longer being able to have a mammogram on the affected breast(s). Women also reported a decline in appearance-related satisfaction over time due to either the ptotic nature of autologous-based reconstruction or the fuller projected breast implant-based reconstruction affords.

Consensus Review of Optimal Perioperative Care in Breast Reconstruction: Enhanced Recovery after Surgery (ERAS) Society Recommendations

BACKGROUND

Enhanced recovery following surgery can be achieved through the introduction of evidence-based perioperative maneuvers. This review aims to present a consensus for optimal perioperative management of patients undergoing breast reconstructive surgery and to provide evidence-based recommendations for an enhanced perioperative protocol.

METHODS

A systematic review of meta-analyses, randomized controlled trials, and large prospective cohorts was conducted for each protocol element. Smaller prospective cohorts and retrospective cohorts were considered only when higher level evidence was unavailable. The available literature was graded by an international panel of experts in breast reconstructive surgery and used to form consensus recommendations for each topic. Each recommendation was graded following a consensus discussion among the expert panel. Development of these recommendations was endorsed by the Enhanced Recovery after Surgery Society.

RESULTS

High-quality randomized controlled trial data in patients undergoing breast reconstruction informed some of the recommendations; however, for most items, data from lower level studies in the population of interest were considered along with extrapolated data from high-quality studies in non-breast reconstruction populations. Recommendations were developed for a total of 18 unique enhanced recovery after surgery items and are discussed in the article. Key recommendations support use of opioid-sparing perioperative medications, minimal preoperative fasting and early feeding, use of anesthetic techniques that decrease postoperative nausea and vomiting and pain, use of measures to prevent intraoperative hypothermia, and support of early mobilization after surgery.

CONCLUSION

Based on the best available evidence for each topic, a consensus review of optimal perioperative care for patients undergoing breast reconstruction is presented.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, V.

Immediate Breast Reconstruction

This article represents findings of a qualitative analysis of interviews with women age 30 to 64 years ( n = 14) who had undergone immediate breast reconstruction (IBR) following mastectomy. The purpose of the study was to explore women’s experiences for electing IBR. According to our analysis, women experienced mastectomy as a disability, and their expectations of IBR to restore their sense of normalcy were not fulfilled. Most women perceived the reconstructed breast mainly as a visual replacement. Women’s experience formed a continuous narrative from the moment of diagnosis, through mastectomy until the completion of the reconstruction.

No one sees the fear: becoming diseased before becoming ill--being diagnosed with breast cancer

BACKGROUND

Breast cancer patients experience profound life changes that include feelings of fear years after concluding treatment.

OBJECTIVE

The aim of this article was to understand the nature and origin of the persistent worry women experience after breast cancer treatment.

METHODS

Materials from participant observation of an oncology ward and from interviews with 17 first-time breast cancer patients, 4 oncologists, and 10 nurses were analyzed. Interpretation of materials was guided by theoretical concepts such as embodiment and liminality to understand the phenomenological aspects and cultural shaping of the illness experience.

RESULTS

Interviewees felt healthy at the time of diagnosis. It was the physician's word that initiated the illness process through the experience of shock. Nurses' work and therapeutic emplotment were instrumental in guiding the women to overcome the shock and engage in treatment. Study participants' lives were restructured under biomedical conditions. This included mistrust toward their bodies. Because of the mode of diagnosis and the initial shock, long-term fear can be seen as an integral part of the experience of having had breast cancer.

CONCLUSIONS

The study participants' sense of being in the world had changed in that their bodies had become objects unto themselves, dangerous objects. Fear became part of women's lives. To control the fear, women relied on biomedical practices to interpret bodily sensations.

IMPLICATIONS FOR PRACTICE

Therapeutic interventions and practices of care that facilitate a reconnection of trust with the (physical) body should be included in the care of posttreatment patients.

Feeling like me again: a grounded theory of the role of breast reconstruction surgery in self-image

The present study aimed to develop a theoretical understanding of the role of breast reconstruction in women's self-image. Semi-structured interviews were conducted with 10 women from breast cancer support groups who had undergone breast reconstruction surgery. A grounded theory methodology was used to explore their experiences. The study generated a model of 'breast cancer, breast reconstruction and self-image', with a core category entitled 'feeling like me again' and two principal categories of 'normal appearance' and 'normal life'. A further two main categories, 'moving on' and 'image of sick person' were generated. The results indicated a role of breast reconstruction in several aspects of self-image including the restoration of pre-surgery persona, which further promoted adjustment.

Qualidade de vida em grupos de mulheres acometidas de câncer de mama

O objetivo deste estudo foi investigar a qualidade de vida de mulheres integrantes de um Grupo de Apoio acometidas de câncer de mama e comparar a qualidade apurada entre as mulheres mastectomizadas que fizeram reconstrução mamária com aquelas que não fizeram além daquelas submetidas à quadrantectomia que não necessitavam da reconstrução com aquelas que não fizeram a reconstrução. Trata-se de estudo transversal quantitativo, cuja coleta de dados se deu por meio da aplicação de questionário de caracterização das entrevistadas e pelo SF-36 da OMS. Participaram 50 mulheres com idade média de 57,2 anos. Os grupos foram comparados entre si - dois a dois - considerando os tipos de cirurgia, por meio do Teste de Mann Whitney, ao nível de 5% de significância. Os resultados apontaram que as mulheres que realizaram a cirurgia de quadrantectomia e não necessitaram de reconstrução são as que possuem os melhores escores médios em todos os domínios e, portanto, têm melhor qualidade de vida, seguido do grupo de mastectomizadas que fizeram reconstrução. O grupo das mastectomizadas que não fizeram a reconstrução tem um nível muito baixo de qualidade de vida, seguido pelo grupo das mulheres que realizaram a quadrantectomia e também não fizeram a reconstrução.

From "no big deal" to "losing oneself": different meanings of mastectomy

BACKGROUND

Because of early detection and advanced treatment options, more women with breast cancer survive after mastectomy and thus have to face the choice of living with or without a reconstructed breast for many years to come.

OBJECTIVE

This article investigates these women's narratives about the impact of mastectomy on their lives, as well as their reflections on breast reconstruction.

METHODS

Fifteen women were strategically chosen from a previous population-based study on mastectomy. They were contacted for further exploration in thematic narrative-inspired interviews 4.5 years after mastectomy.

RESULTS

Three types of storylines were identified. In the first storyline, the mastectomy was described as "no big deal"; losing a breast did not disturb the women's view of themselves as women, and breast reconstruction was not even worth consideration. In the second storyline, the women described the mastectomy as shattering their identity. Losing a breast implied losing oneself as a sexual being, a woman, and a person. The third storyline fell in between the other two; the sense of femininity was wounded, but not to the extent that they felt lost as women.

CONCLUSION

Our findings suggest that the experience of mastectomy due to breast cancer is very much individual and contextual. Losing a breast may be of minor or major importance.

IMPLICATIONS FOR PRACTICE

Healthcare practitioners should be attentive to how the women themselves experience the personal meaning of losing a breast and guard against vague preconceptions based on the breast-sexuality-femininity discourse and its connection to what the patient needs.

Women's recovery experiences after breast cancer reconstruction surgery

Many women with early-stage breast cancer choose breast reconstruction following mastectomy with the goal to improve physical and psychological quality of life. Breast reconstruction procedures vary in surgical complexity, types of postsurgical complications, and time to recovery, all of which can affect a women's well-being. Although there is a growing body of literature on the satisfaction with aesthetic outcomes following breast reconstruction, there is little research addressing the recovery process. This qualitative study explores woman's physical and emotional recovery experiences. Findings may be useful for improving educational and counseling services for women who undergo breast cancer reconstructive surgeries.

Imagem corporal de mulheres com câncer de mama: uma revisão sistemática da literatura

A mulher passa por um importante processo de reformulação da imagem corporal quando lida com o câncer de mama. Este artigo objetiva a compreensão da relação que o câncer de mama e seus tratamentos têm no processo de (re)elaboração da imagem corporal das mulheres, visando assim ao fomento de subsídios para a formação e a capacitação de profissionais de saúde mais atentos à promoção da qualidade de vida delas. Foi realizada uma revisão sistemática da literatura de artigos científicos publicados entre 2004 e 2009 disponíveis em três bases de dado; 56 artigos foram revisados e agrupados em quatro categorias. Destacamos a necessidade de mais estudos que contemplem características socioculturais de mulheres com câncer de mama, sobre diferenças na (re)elaboração da imagem corporal de mulheres jovens e de mulheres mais velhas, e de publicações brasileiras sobre a experiência pessoal e aspectos socioculturais específicos de mulheres com câncer de mama.

The ethical community consultation model as preparation for nursing research: a case study

This article describes a case study in which community consultation was used to assist in the preparation of a research project on viewing self in the mirror after mastectomy. Breast cancer survivors, nurses, and other health care professionals were consulted using a variety of interactive modalities. Over a period of three months, pre-research planning information was obtained from participants. A descriptive qualitative design was used to analyze the data. The ethical goals of community consultation provided the framework for dialogue and the synthesis of information. During this project, the potential benefits of the proposed research study were explored. Possible risks to future participants were discussed, and recommendations for participant protection suggested. Community members provided insight into the legitimacy of the study. Community consultation is a tool that researchers may consider when designing studies.

A meta-synthesis of women's symptoms experience and breast cancer

The aim of this paper is to examine the symptom experience of women with breast cancer using meta-synthesis. Women with breast cancer may experience many symptoms resulting from the primary disease and/or treatment of the disease. It is very important the overall symptom experience from the patients' perspective is captured and understood by health professionals. The question developed was 'What is the symptom experience of women with breast cancer from time of diagnosis to completion of treatment'. The meta-synthesis process as developed by Sandelowski and Barroso was used to collect and analyse the data. The overarching idea emerging from this meta-synthesis is that the symptoms experience for women with breast cancer has effects on the very 'self' of the individual. Emerging is women's need to consider the existential issues that they face while simultaneously dealing with a multitude of physical and psychological symptoms. This meta-synthesis develops a new, integrated, and more complete interpretation of findings on the symptom experience of women with breast cancer. The results offer the clinician a greater understanding in depth and breadth than the findings from individual studies on symptom experiences.

A guide to qualitative research in plastic surgery

SUMMARY

Qualitative research can explore parts of the subjective patient experience that cannot be detailed with quantitative methods such as surveys. Unfortunately, this powerful methodology is underused in plastic surgery, a specialty where subjective outcomes are more important than traditional outcomes indicators. Qualitative research can be used to add depth to patient satisfaction questionnaires or other quantitative measures. Qualitative methodology can also be used to explore complex issues such as why patients choose to undergo cosmetic surgery or to detail patient experiences following reconstructive surgery. The authors explain the basics of qualitative research, including asking the appropriate research question, applying steps to collect data, data analysis, and practical applications of the results.

Therapeutic mirror interventions: an integrated review of the literature

The mirror is an object that shows one a reflected image of body areas. There appears to be limited nursing literature about the role of a nurse in the use of a mirror. There is, however, literature of the therapeutic use of mirrors in medicine, neurology, psychiatry, psychology, physical medicine and rehabilitation, and rheumatology. The objective of this article is to review the basic elements and the underlying theoretical framework of mirror interventions. In 2007 to 2008, a keyword, abstract, and title search was conducted for therapeutic mirror studies between the years 1998 and 2008. A multidisciplinary, integrated review approach was used when it became apparent that there were limited nursing studies. Qualitative and quantitative strategies for reviewing evidence were used, and a narrative synthesis approach was used to guide the comprehensive synthesis. Underlying theoretical models were identified, and five elements of mirror interventions were synthesized from the literature.

Alterations of sexual function in women with cancer

OBJECTIVES

To provide an overview of the alterations in sexuality and sexual function that occur in women with cancer.

DATA SOURCES

Research and review articles, books, clinical experience.

CONCLUSIONS

Although initial concerns of women with cancer may not focus on sexuality issues, most women want support in dealing with body changes. Cancer and cancer treatment for women can result in changes in sexuality and sexual function that may or may not improve over time. Sexual assessment can provide the basis for various approaches to intervention.

IMPLICATIONS FOR NURSING PRACTICE

Sexual assessment is an essential part of nursing practice across the trajectory of cancer. With this information, nurses can plan interventions tailored to address these important alterations in the lives of women with cancer.