The effects of hysterectomy on body image, self-esteem, and marital adjustment in Turkish women with gynecologic cancer

Predictors of significant distress in cervical cancer patients: a cross sectional study

PURPOSE

This cross-sectional study aims to investigate parameters that predict relevant levels of distress in women in a perioperative setting undergoing treatment for cervical cancer.

MATERIALS AND METHODS

Data from 495 patients with cervical cancer that were treated at the university hospital Aachen between 2010 and 2022 were analysed based on their respective National Comprehensive Cancer Network (NCCN) Distress Thermometer score (DT) and Problem List (PL) and their clinical history. 105 patients were enrolled in the study. 18 medical and demographic variables were analysed using multivariate logistic regression.

RESULTS

Three variables contributed significantly to the prediction of a DT score ≥ 5. Significant distress was defined as a DT score of ≥ 5, which was observed in 70.5% of the participants (mean: 5.58 ± 2.892). Women who chose to receive psycho-oncological counselling were more likely to have a DT score ≥ 5 (Odds Ratio(OR) = 3.323; Confidence Interval (CI95%): 1.241-8.900; p-value: 0.017). In addition, women who did not receive chemoradiation had significantly higher DT scores (OR = 3.807; CI 95%:1.185-12.236; p-value: 0.025), as did women whose Distress Thermometer was assessed in the first month after their initial diagnosis (OR = 3.967; CI 95%:1.167-13.486; p-value: 0.027).

CONCLUSION

Increased distress in women with cervical cancer is common especially in the first month after diagnosis, in patients who do not receive chemoradiation and in patients who seek psycho-oncological counselling. Surgical factors do not play a major role in patient distress.

The effectiveness of psychological interventions for reducing poor body image in endometriosis, PCOS and other gynaecological conditions: a systematic review and meta-analysis

Gynaecological conditions (e.g., endometriosis, PCOS) result in bodily changes that negatively impact body image. Psychological interventions (e.g., CBT, psychoeducation) have shown promise in reviews with the general population for alleviating body image concerns. This systematic review and meta-analysis aims to provide asynthesis of the impact of psychological interventions for reducing body image concerns for individuals with gynaecological conditions. Electronic databases were searched for relevant psychological intervention studies with body image outcomes. Twenty-one eligible studies were included in the systematic review (ten were included in a random-effects meta-analysis). Studies included participants (N = 1483, M = 71.85, SD = 52.79) with a range of gynaecological conditions, ages (Mage = 35.08, SD = 12.17) and cultural backgrounds. Most included studies reported at least one positive effect with the meta-analysis indicating psychological interventions were moderately superior to control conditions for reducing body image concerns (SMD -.41, 95% CI [-0.20 -0.62]). However, there was a high risk of bias and moderate heterogeneity. Results suggest psychological interventions may hold promise for reducing body image concerns among individuals gynaecological conditions in the short term. Further, preliminary support was found for the use of theory-guided psychological interventions delivered in group settings in particular, with further research needed on optimal intervention length and particular psychotherapeutic approach.

Examining the changes in women's lives after the hysterectomy operation: Experiences of women from Turkey

PURPOSE

The aim of the study is to examine what kind of changes the operation has brought about in the social and psychological life of women.

METHODS

The study was a hermeneutic-phenomenological research conducted using qualitative research methods. It took place between May and July 2023 at a university hospital located in Istanbul, Turkey. Following ethical approval, the study included a total of 24 women who had undergone a 'total abdominal hysterectomy, bilateral salpingo-oophorectomy.' These participants were selected using a combination of maximum diversity sampling and random sampling methods. Data collection was carried out using a semi-structured interview form. The interviews were conducted using face-to-face interview techniques and in-depth interview methods. Qualitative data analysis involved using the coding paradigm of Grounded Theory and Straus and Corbin's coding framework. For the analysis of quantitative data, SPSS version 28.0 was employed, while qualitative data were analyzed using MaxQDA Analytics Pro 2022.

RESULTS

The study found that the participants had a mean age of 47 ± 7.53, and the majority, 66.7%, had not reached menopause before the operation. The qualitative analysis of the semi-structured interviews revealed five main themes, which were identified as follows: 'hysterectomy experiences', 'the impact of hysterectomy on sexual life', 'the significance attributed to the uterus', 'the significance attributed to femininity', and 'self-efficacy after hysterectomy'.

CONCLUSIONS

The study revealed that women experienced changes in self-perception, body image, a sense of organ loss, and developed negative attitudes towards menopause following a hysterectomy. Additionally, there was a noticeable connection between the meanings attributed to the uterus and femininity, which was often influenced by cultural and social factors. In light of these findings, it is recommended that women receive counseling from healthcare professionals before undergoing a hysterectomy. This guidance can help women better understand and cope with the physical, emotional, and cultural aspects of the procedure.

Development of an evidence‑based, theory‑driven, and culturally appropriate character strengths-based intervention for breast cancer patients, following the Medical Research Council Framework

PURPOSE

To design and develop a complex, evidence‑based, theory‑driven, and culturally appropriate character strengths-based intervention (CSI) for breast cancer patients, following the Medical Research Council (MRC) framework.

METHODS

From 2018 September to 2020 November, a complex intervention perspective was adopted. The rationale, methods, and processes employed in carrying out the study were reported. The acceptability and feasibility of intervention program were evaluated as a part of subsequent pilot study. Based on piloting, a refined and optimized definitive intervention was obtained. The development of the intervention is an iterative process involving input from three key stakeholders: experts, medical staff, and patient representatives.

RESULTS

The systematic review revealed CSIs were effective and the selected theory served as a guide and indicated theory-inspired modifications. A representative team of breast cancer patients and oncology nurses collaboratively developed and tailored the intervention content and format with attention to the acceptability and feasibility. Five main strategies, including peripheral, evidential, linguistic, constituent-involving, and sociocultural strategies, were used to achieve and strengthen the cultural appropriateness. After the pilot phase, several refinements were made on the CSI program, such as editorial changes in the booklet or alternative suggestions for difficult strengths-based activities (e.g., outdoor activities). All participants not only expressed satisfaction with the program in process evaluation, but also reported perceived benefits such as enjoyable and sociable experience, better well-being, and increased confidence.

CONCLUSION

Consideration of the MRC framework, theory guidance, and suggestions from stakeholders during intervention development can optimize uptake and sustainability in the clinical setting. It is recommended that randomized controlled trial be used in future studies to assess the intervention, the process and the mechanisms of the intervention. Our approach may offer implications for the design and implementation of similar initiatives to support cancer patients.

TRIAL REGISTRATION

ClinicalTrials.gov Register Identifier: NCT04219267, 07/01/2020, retrospectively registered.

Effects of Surgical and Natural Menopause on Body Image, Self-Esteem, and Dyadic Adjustment: A Descriptive and Comparative Study

This study aimed to assess body image, self-esteem, and dyadic adjustment in surgically menopausal, naturally menopausal, and perimenopausal women. This descriptive and comparative study was conducted in the clinics and polyclinic of a university hospital with a total of 274 women: 91 in the surgical menopause, 91 in the natural menopause, and 92 in the perimenopause groups. An Individual Introduction Form, the Body Cathexis Scale (BCS), Rosenberg Self-Esteem Scale (RSES), and Dyadic Adjustment Scale (DAS) were used for data collection. The women in the surgical menopause group had significantly higher mean scores for RSES and BCS and lower mean scores for DAS than the women in the natural menopause and perimenopause groups, with the higher BCS and RSES scores indicating lower self-esteem and body satisfaction. A weak negative correlation was found among dyadic adjustment, self-esteem, and body image of women in the surgical menopause group. Results showed that body image, self-esteem, and dyadic adjustment in menopausal women were impaired. This impairment was greater in the surgical menopause group than in the natural menopause group. Additionally, the presence of comorbid chronic diseases, less education, and being overweight negatively affected dyadic adjustment in women. Clinicians' awareness of the importance of the psychological aspects of menopause and the difference in the effects of menopause transition on mental well-being (body image, self-esteem, and marital harmony) according to the occurrence of menopause will enable them to help patients cope more easily with this process.

Husband’s and Health Workers Support Increase Self-acceptance After Hysterectomy

Background: There have been many studies on the importance of various interventions to increase self-acceptance after hysterectomy, but in general none of the above studies have explained the importance of husband and health workers' support in increasing self-acceptance after hysterectomy. This study aims to analyze the correlation between husband's support and health workers with self-acceptance after hysterectomyMethods: The data measured were the support of husbands and health workers as well as self-acceptance obtained from women after hysterectomy through the SAS-EB (Self-Acceptance - Scale for Persons with Early Blindness) questionnaire to measure self-acceptance and a questionnaire containing support to measure support from husbands and health workers. Statistical analysis used was Chi Square to analyze the support of husbands and health workers with self-acceptance after hysterectomyResult: This study found the importance of husband's support, especially support from health workers. The most important support from health workers is the provision of information about hysterectomy including care before and after hysterectomyConclusion: In general, this study proves that husband's and health workers support increase self-acceptance after hysterectomy

Women's interdependence after hysterectomy: a qualitative study based on Roy adaptation model

Background

Hysterectomy is a difficult process that some women encounter that can affect their interdependence, but its impact on women’s Interdependence has received less attention. Therefore, this study aimed to explain women’s Interdependence after hysterectomy.

Methods

This qualitative study was performed using a directed content analysis approach in Mashhad (Iran). Thirty women with a history of hysterectomy were included in the study by purposive sampling method. Data were collected from August 2018 to November 2019 using semi-structured interviews based on the interdependence mod of the Roy adaptation model until data saturation. Data analysis was performed using MAXQDA software and the deductive approach of Elo and Kingas (J Adv Nurs 62(1):107–115, 2008. 10.1111/j.1365-2648.2007.04569.x).

Results

Data analysis led to the production of 537 initial codes from participants’ experiences. By merging and categorizing them, the theme of “increasing interdependence” emerged, which consists of 2 categories: “Evolution independence and interaction with important people in life” and “Reinforced support system”, that include six subcategories.

Conclusion

After hysterectomy, women not only feel a strong need for support from family members, especially their husbands, they are also seeking support from health care providers and their colleagues. Before the hysterectomy, it is recommended that family members be consulted to ensure the emotional support and care of women after the hysterectomy. It can help the adaptation to hysterectomy.

The holistic needs of women with hysterectomy: A grounded theory study

The objective of study is to qualitative assess for identify the holistic needs of childbearing age women with hysterectomy. This study use grounded theory qualitative study method. The participants in this study were six childbearing age women post hysterectomy, husbands, family members, and three healthcare workers. This study was conducted in West Sumatra Province with Minang culture which adheres to matrilineal kinship system. The results of this study there are seven elements that develop concept of holistic needs on women with hysterectomy. Consists of the need to deal with sexual problems and pain, to be cared by the family, to be more active, to improve relationships with God and self-acceptance, and community values to accept women with hysterectomy. The needs of women with hysterectomy were holistic needs. Nurses can do assessments to understand holistically the needs of women with hysterectomy.

Iranian Women's Self-concept after Hysterectomy: A Qualitative Study

Background:

The loss of female organs leads to profound changes in one's perception of oneself. There is limited information about the impact of hysterectomy on women's self-concept and culture. Therefore, this study was conducted with the aim to deepen our understanding of the self-concept of Iranian women after hysterectomy.

Materials and Methods:

This qualitative study was conducted using directed content analysis approach. The participants included 30 women with a history of hysterectomy who were selected through purposive sampling method. Data were collected from August 2018 to November 2019 using in-depth and semi-structured interviews based on the self-concept mode of the Roy Adaptation Model (RAM) in Mashhad, Iran. Data analysis was performed using the deductive approach of Elo and Kyngäs in MAXQDA software.

Results:

As a result of the analysis of the interviews, the main category of “incoherent cognition of self-concept” emerged, which included the two generic categories of “heterogeneous feelings toward and imaginations of the body” and “changed self-perception”, and five subcategories.

Conclusions:

Women's self-concept changed after hysterectomy in both its physical and psychological aspects. Therefore, counseling before and after hysterectomy is recommended to improve women's self-concept after hysterectomy.

M, Belaid A, Gargouri W, Nasr C. Évaluation de l’image du corps chez des femmes traitées pour un cancer utérin

Introduction : À l’heure actuelle, le retentissement des cancers utérins, ainsi que leur traitement sur l’image du corps, demeure un sujet peu étudié en Tunisie et souvent négligé aussi bien par les praticiens, les malades et leurs partenaires.

Méthodes : Il s’agit d’une étude transversale descriptive colligeant 100 patientes tunisiennes suivies à l’institut Salah- Azaïez pour un cancer de l’endomètre ou du col utérin confirmés histologiquement et non métastatiques, avec un recul supérieur à six mois. Nous avons utilisé l’échelle Body Image Scale (BIS) et Female Sexual Function Index (FSFI). Nous avons collecté les antécédents personnels et familiaux, et différentes données sociodémographiques des patientes.

Résultats : Dans notre étude, 40 % des patientes ont des troubles de l’image du corps. La moyenne du score BIS était de 12,03 avec des extrêmes allant de 0 à 30 avec un écarttype de 7,88. En analyse univariée, l’absence du soutien familial, l’altération de la relation de couple et de la relation sexuelle, la mauvaise tolérance de la chirurgie et la curiethérapie utérovaginale étaient significativement associées à l’altération de l’image corporelle. En analyse multivariée, le bas niveau socio-économique était le facteur indépendant protecteur du trouble de l’image du corps, et la dysfonction sexuelle était le facteur indépendant prédicteur de ce trouble.

Conclusions : Le manque de communication des patientes avec leur conjoint et avec l’équipe de soin constitue l’un des principaux obstacles lorsqu’il s’agit de reconnaître et de traiter ce problème. Des stratégies préventives visant à maintenir une image corporelle positive chez ces femmes devraient être entreprises.

Anxio-depressive symptoms in Moroccan women with gynecological cancer: Relief factors

INTRODUCTION

Psychosocial determinants can affect the mental health of women who have been diagnosed with gynecological cancer. The aim of this study was to examine how social support and self-esteem are associated with anxiety and depression symptoms in women with gynecological cancer, and who are treated by radical surgery.

METHODS

A cross-sectional study was performed, within the oncology department of Ibn Rochd University Hospital, Casablanca, on 100 Moroccan women. They all had undergone radical surgery for gynecological cancer, hysterectomy and/or oophorectomy.

RESULTS

Our results showed that patients with gynecological cancer treated by radical surgery exhibited high prevalence rates of anxiety (66%) and depression symptoms (59%). Associations showed that age, having children, medical coverage system, area of residence, working status and socioeconomic status were significantly related to the prevalence of anxiety and depression symptoms (P<0.05). The general social support, family support and significant other support besides high self-esteem reduce significantly the risk of getting anxiety and depression symptoms (P-values<0.05).

DISCUSSION

Among patients with gynecological cancer treated by radical surgery, high prevalence of anxiety and depression symptoms was found. Social support and high self-esteem could help improve mental health issues related to this type of cancer.

Experience of Palestinian Women After Hysterectomy Using a Descriptive Phenomenological Study

Background:

Universally, hysterectomy is considered as the second most frequent surgery after cesarean section performed on women in the reproductive age. After a hysterectomy, women no longer have menstrual periods, so they cannot become pregnant. Like most other countries, hysterectomy is the most common major gynecological operation in Palestine. However, the psychological, physical, and sexual consequences of hysterectomy are conflicting, and the findings are mixed. While some studies report that patients experience more significant improvement in their mental health, sexual desire, and overall satisfaction, other studies show that patients report various adverse outcomes, with detrimental effects on sexual functioning being the main concern.

Objective:

This study aimed to describe women's experiences of hysterectomy and identify their fears, concerns, and what coping mechanisms do they adopt to enhance the quality of their lives.

Methodology:

Qualitative descriptive phenomenological research design was used in this study. The study aims to gain insight into the experiences of fifteen patients after hysterectomy using semi-structured in-depth interviews. The interview was conducted in both private and governmental hospitals using purposeful sampling.

Results:

Giorgi's phenomenological analysis process was used as a tool for analyzing data. Analysis of the interview transcripts led to five themes, including a total of eighteen subthemes. The first theme is physical change that has pain, insomnia, eating habits, and immobility as subthemes. The second theme is psychological changes with depression, de-socialization, anxiety, and aggressiveness as its subthemes. The third theme is defense mechanisms with praying, listening to music, reciting the Holy Quran, walking, and sports as subthemes. The fourth theme is self-esteem and body image with confidence, appearance, and concerns as subthemes. Lastly, the fifth them is sexuality with excitement and sexual pattern as subthemes.

Conclusion:

The results of this study demonstrated that hysterectomy had significant adverse effects on patients' body image, and self-esteem. Moreover, the study identified common meanings and themes associated with hysterectomy stressors. These are difficulties or limitations in physical and psychological aspects perceived by patients after hysterectomy. The health care provider must be aware of these potentially problematic issues to provide competent health care.

Effect of psychological care given to the women who underwent hysterectomy before and after the surgery on depressive symptoms, anxiety and the body image levels

This study was conducted for the purpose of evaluating the effect of the psychological care given to women before and after hysterectomy surgery on depression levels, anxiety and body image. This experimental study was conducted in the gynecological oncology surgery clinic of Samsun Education and Research Hospital in Turkey between the dates of January 2018 and June 2018. Those who meet the sample selection criterion and agreed to participation to the study among the women who were admitted to the clinic for hysterectomy were assigned randomly to the experimental and control groups. 42 women in total including 21 women in each of experimental and control groups formed the sample of the study. The effect of the psychological care was evaluated through Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI) and Body Catherix Scale (BCS). The evaluation measurements were conducted as pre-test, post-test and follow-up (2-months post-test). The BDI and STAI scores of the women who receive psychological care have decreased and their BPS scores have increased. On the contrary, BDI and STAI scores of the women who receive psychological care in the experimental group have increased and their BCS scores have decreased. These findings show that psychological care has positive effects on depressive symptoms, anxiety and the body image in the women who underwent hysterectomy.IMPACT STATEMENTWhat is already known on this subject? Having a hysterectomy impacts a woman's life in a significant manner. As such, deciding to undergo a hysterectomy is a difficult process for women, especially from a psychological perspective. Following a hysterectomy, women commonly experience changes in body perception, such as perceiving the body as different, feeling disabled, feeling hollow, believing they are different than other women and feeling that their body is attracting notice. The literature reports that women perceive themselves as different, alienated, impaired and changed after a hysterectomy and that they have difficulty making contact with the environment; furthermore, the more changes in body perception increase, the more depression increases.What the results of this study add? This study revealed that psychological care given to women before and after undergoing a hysterectomy decreases anxiety and increases positive body perception. For this reason, psychological care for women undergoing hysterectomies should be part of routine nursing care and should be started upon the hospitalisation of the patient.What are the implications of these findings for clinical practice and/or further research? The findings of this study indicate that after a hysterectomy, women experience not only physiological disease symptoms but also psychological problems. Therefore, women who have undergone or will undergo a hysterectomy also have psychological needs. Further study is suggested to determine what can be done with a professional team to meet the demands for psychological care.

UK criteria for uterus transplantation: a review

Absolute uterine factor infertility is the final hurdle for assisted reproductive treatments. Uterus transplant trials are happening worldwide; to advance the debate around uterine transplantation (UTx), this article considers selection criteria for clinical trials from a UK perspective and makes recommendations for future selection criteria for UTx treatment. Recommendations advanced include the use of donor eggs, access for single women and women in same-sex relationships, prohibiting participation of women who are already mothers, and a preference for deceased donors and bioengineered uteri. With UTx treatment on the horizon, it is important to proactively consider future selection criteria. TWEETABLE ABSTRACT: Review of UK selection criteria for clinical trials for uterus transplantation; recommendations for the future.

"Health in the Mirror": An Unconventional Approach to Unmet Psychological Needs in Oncology

Background: The introduction of aesthetic care programs for cancer patients inside hospitals could help patients cope with the side effects of both disease and treatment. The specific objective of this study is to evaluate whether a complementary and supportive program, called "Health in the Mirror," has a positive effect on participants by analyzing certain psychological variables. Methods: Eighty-eight female cancer patients were included in this analysis. The support program is composed of three group aesthetic interventions that address both physical and psychological aspects that accompany cancer and its treatment. Patients were asked to complete a battery of tests in order to measure the impact of the program on certain psychological variables including anxiety, depression, body image, self-esteem, and quality of life. Outcome variables were measured at three different time-points: prior to participation, on the last day of the program, and after a 3-month follow-up. Results: Participating in the psychosocial support program "Health in the Mirror" determines an improvement in the psychological variables measured. Results revealed a significant reduction in depressive symptoms, anxiety and body image issues, as well as an improvement in self-esteem levels; this suggests that participating in this program could facilitate better adjustment to disease and treatment. Discussion: This study legitimizes the importance of implementing supportive and complementary therapies together with conventional therapies; the therapeutic approach to cancer cannot be restricted solely to medical care, but it must consider the patient as a whole person with needs that are not only physical or medical, but also psychological, social, and existential.

Pragmatic prevention, permanent solution: Women's experiences with hysterectomy in rural India

Hysterectomy appears to be on the rise amongst low-income, rural women in India as routine treatment for gynaecological ailments. This paper explores the individual, household, socio-economic and health system factors that influenced women's decisions to undergo hysterectomy in rural Gujarat, with a focus on women's perspectives. Interviews were conducted with 35 rural, low-income women who had undergone hysterectomy, local gynaecologists and other key informants, alongside observation of daily life and health-related activities. Inductive, open coding was conducted within a framework analysis to identify thematic influences on the decision to undergo hysterectomy. Women underwent hysterectomy at an average age of 36, as treatment for typically severe gynaecological ailments. I argue that women, faced with embedded social inequality in the form of gender biases, lack of labour security and a maternal-centric health system, demonstrated pragmatic agency in their decision to remove the uterus. When they experienced gynaecological ailments, most sought two to three opinions and negotiated financial and logistical concerns. The health system offered few non-invasive services for non-maternal health issues. Moreover, women and health care providers believed there is limited utility of the uterus beyond childbearing. Women's responsibilities as caretakers, workers and producers drove them to seek permanent solutions that would secure their long-term work and health security. Thus, hysterectomy emerged as a normalised treatment for gynaecological ailments, particularly for low-income women with limited resources or awareness of potential side effects. In this setting, hysterectomy reflects the power structures and social inequalities in which women negotiated medical treatment--and the need to reverse a culture of permanent solutions for low-income women.

Quality of life in gestational trophoblastic neoplasia patients after treatment in Thailand

BACKGROUND

Gestational trophoblastic neoplasia (GTN) is a malignant disease which occurs in women of reproductive age. Treatment of GTN has an excellent outcome and further pregnancies can be expected. However, data concerning quality of life in these cancer survivor patients are limited. This study aimed to assess quality of life in women who were diagnosed with GTN and remission after treatment, and to determine factors that may affect quality of life status.

MATERIALS AND METHODS

This cross sectional study was conducted from July 2013 to May 2014 in the Gestational Trophoblastic Disease Clinic, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Patients who were diagnosed GTN and complete remission were recruited. Data collection was accomplished by interview with two sets of questionnaires, one general covering demographic data and the other focusing on quality of life, the fourth version of Functional Assessment of Cancer Therapy (FACT-G). Descriptive statistics were used to determine general data and quality of life scores. Students t-test and one way ANOVA were used to compare between categorical and continuous data.

RESULTS

Forty four patients were enrolled in this study. The overall mean quality of life score (FACT-G) was 98.2. The overall FACT-G score was not significantly correlated with age, education level, stage of disease, treatment modalities, and time interval from remission to enrollment. However, patients who needed further fertility showed significant lower FACT-G scores in the emotional well-being domain (p=0.02).

CONCLUSIONS

Overall quality of life scores in post-treatment gestational trophoblastic neoplasia patients are in the mild impairment range. Patients who desire fertility suffer lower quality of life in the emotional well-being domain.

Social support buffers the effect of self-esteem on quality of life of early-stage cervical cancer survivors in Taiwan

PURPOSE

The purpose of this study was to examine the effects of self-esteem and social support on quality of life (QoL) in stage I and II cervical cancer survivors.

METHOD

The sample consisted of 110 participants who had been diagnosed with stage I-II cervical cancer and had completed their treatment 5 years or more before data collection. Each participant completed four structured questionnaires: a demographic-disease survey, the Rosenberg Self-Esteem Scale, Medical Outcomes Study Social Support Survey, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire 30. Data were analyzed using descriptive statistics, independent sample t-test, one-way ANOVA, and hierarchical multiple linear regression analyses.

RESULTS

The participants' mean age was 60.74 ± 10.69 years. Better QoL was significantly associated with younger age, higher self-esteem, and stronger social support; in addition, social support buffered the effect of self-esteem on global QoL. Together, five variables (age, time since treatment, self-esteem, social support, and the interaction term of self-esteem and social support) explained 36% of the variance in global QoL, with self-esteem being the strongest predictor.

CONCLUSIONS

The results of this study advance current knowledge of QoL in cervical cancer survivors by demonstrating that survivors with low self-esteem and social support tend to have lower QoL than those with low self-esteem but high social support. Health professionals should help survivors seek support and provide appropriate strategies to expand their social networks and enhance their self-esteem to improve their global QoL after cervical cancer.

Reliability and validity of the Dutch-translated Body Image Scale

PURPOSE

Lacking a comprehensible and widely applicable Dutch test to assess body image changes in cancer patients, we validated Hopwood's Body Image Scale (BIS) for the Dutch language.

METHODS

The BIS consists of 10 items scored 0-3. Total scores range from 0 (minimum body image-related distress) to 30 (maximum distress). After forward and backward translation of the BIS, we evaluated its psychometric characteristics in breast cancer patients. We assessed feasibility by missing answer rates and positive response prevalence (score ≥ 1) per item (criterion ≥ 30 %), test-retest reliability with a 2-week interval, internal consistence using Cronbach's α and discriminant ability by comparing body image after breast-conserving therapy (BCT) versus mastectomy.

RESULTS

Psychometric evaluation of 108 BCT and 101 mastectomy patients showed high feasibility (0.2 % missing answers), high positive response prevalence of ≥ 30 % in 9/10 items and high internal consistency (α > 0.90). Test-retest reliability and correlation were high with 5.78 (test) versus 5.75 (retest; P = 0.86) and Spearman's ρ = 0.92 (P < 0.01). Discriminant ability was good with BIS scores of 4.56 after BCT versus 7.19 after mastectomy (P < 0.01). All results were comparable to the results of the original BIS.

CONCLUSION

The Dutch-translated BIS showed excellent psychometric results very similar to the original BIS. Its concise and simple design further supports wide application in clinical practice.

Reasons for middle-aged women in Taiwan to choose hysterectomy: a qualitative study using the bounded rationality perspective

AIMS AND OBJECTIVES

To explore women's perspectives on deciding to undergo hysterectomy for benign conditions based on physicians' recommendations and the women's own judgement.

BACKGROUND

Hysterectomy is the second most common surgical procedure worldwide. Although most hysterectomies are elective, physicians may recommend treatment that involves a loss of sexuality or ovary removal, creating a difficult choice for women.

DESIGN

Qualitative, in-depth interview

METHODS

A purposive sample of 17 women was recruited. The women had decided to undergo hysterectomy after the diagnosis of uterine fibroids. All these women had already decided not to have more children. Data were collected by in-depth interviewing, and content analysis was used to analyse the data.

RESULTS

Our study revealed five themes: release from stress, inescapable fate, positive support, hoping for peace of mind and sense of trust.

CONCLUSIONS

The participants felt that mental and physical health were the most important considerations, noting that when women no longer want children, a uterus is useless. The women believed that they retained their womanhood, even without a uterus, and were satisfied with the outcomes of their hysterectomy decisions.

RELEVANCE TO CLINICAL PRACTICE

Our findings might serve as educational and counselling reference materials for healthcare providers, ensuring that women receive appropriate care quality and have their needs met. Healthcare providers can then maximise women's empowerment, deepen their awareness of body image and their concept of self-care and help them to clearly perceive their own concerns and needs so that they can make suitable decisions.

Relationship in Japan between maternal grandmothers' perinatal support and their self-esteem

This study investigated the influence on their mental well-being of the perinatal support given by Japanese grandmothers.

The Rosenberg self-esteem and the Center for Epidemiologic Studies Depression (CES-D) scales were used to assess grandmothers’ mental well-being before and after their daughters’ childbirth. Of 198 grandmothers, 176 (88.9%) supported their daughters and three patterns of perinatal support were observed: grandmothers’ support at the grandparents’ house before childbirth (n = 95) (Satogaeri bunben; Japanese traditional perinatal support), grandmothers’ support at the grandparents’ house after childbirth (n = 53); and grandmothers’ support at the daughters’ house (n = 28).

Those who supported their daughters at the grandparents’ house before childbirth – especially the middle-aged (less than 60 years old) – showed significantly lower scores of self-esteem. Scores of CES-D did not significantly change before and after childbirth in either subgroup of grandmothers. It was concluded that grandmothers play an important role in supporting their daughters, and Satogaeri bunben is a typical event in modern Japan. However, Satogaeri bunben is a burden for middle-aged grandmothers, and we need to support them.