published_or_final_version / abstract / toc / Social Work and Social Administration / Doctoral / Doctor of Philosophy

There is considerable evidence that delays in diagnosing and treating breast cancer reduce long-term survival. The purpose of this study was to assess the waiting time between diagnosis and treatment for Alberta women with breast cancer and to examine the influence of age, cancer stage, Regional Health Authority (RHA), community size, and year of diagnosis on this time interval. The data were obtained from the Alberta Cancer Board. The information included approximately all Alberta women with breast cancer between 1997 and 2000. The overall median waiting time was 17 days. The mean and median delay increased by an average of two days each year. Only 43.8% of cases were treated within the recommended 14 days. The delay was significantly longer for women younger than 70, with stage 1 disease and from Northern RHAs. Efforts must be made to decrease delay and ensure that all women receive equal access to health services. / xii, 106 leaves : ill. ; 28 cm.

This research is a follow up of a "Breast Week" which was organized in Freetown, Sierra Leone. The specific objective of this study was to assess the effectiveness of the knowledge and teachings given to the women who participated in this project. The unrecorded cases of breast lumps and breast cancer observed in women in Sierra Leone prompted the researcher to undertake this present study. A quantitative approach was adopted and a structured interview schedule and an observational checklist guided the data collection process. A sample size of 120 women (10%) who participated in the "breast week" was obtained through systematic sampling. The first part of the study involved assessment of the theoretical background of the research topic followed by the second phase during which the women demonstrated Breast Self-Examination to detect abnormalities of the breasts. Discussions and analysis of the findings are presented in three sections. Texts from open ended questions were categorized and explained in numerical terms as the study was quantitative in nature. The data was processed through use of SPSS and Microsoft Excel. Frequency counts were applied to the data, use of non-parametric tests on the number of women who practiced Breast Self-Examination before and after the breast week showed a statistically significant difference in the number of women now practicing BSE as a screening method for breast cancer after receiving the health education. It was found that the majority of the women linked breast cancer to the signs and symptoms associated with it and were able to describe the disease as one that kills women if not promptly detected and/or treated appropriately. Findings indicate that the majority of the women (78.3%) had previously had mmor breast problems. An assessment of the effectiveness of knowledge on breast cancer showed that these women could identify breast cancer as a disease that affects women and may cause deaths if not detected on time or treated promptly. These women were able to demonstrate to the researcher how they examine their breasts to exclude abnormalities. Three women had breast lumps detected through examination of the breasts during the breast week. Two of them had had the lumps removed and are currently on medication. One of the women who had a breast lump detected was financially constrained and could not afford the cost of surgery. The number of women who can now perform BSE increased (95.0%) after having the knowledge on breast cancer and BSE. The majority of the women (97.4%) received information on how to examine their breasts for breast cancer through the information provided during the breast week. It is thus concluded that the objectives of the breast week were met. / Thesis (M.N.)-University of Natal, Durban, 2004.

SAMMANFATTNING Bakgrund Vid ett cancerbesked ges mycket information som kan ge psykologiska reaktioner hos patienten.  Att ge individuellt stöd, information och ett bra bemötande är viktigt för att patienten ska känna sig trygga och delaktig i sin vård. Syfte Att utvärdera bröstcancerpatientens upplevelse av information, stöd, bemötande och delaktighet i samband med sitt återbesök hos kontaktsjuksköterska efter operation på Bröstmottagning. Metod En tvärsnittsstudie med kvantitativ ansats då huvudfokus var patientens upplevelse av information, stöd, bemötande och delaktighet. Patienterna fick svara på en elektronisk enkät direkt efter sitt återbesök på mottagningen. Totalt svarade 48 patienter på enkäten. Resultat  Resultatet visade en mycket hög nöjdhetsgrad bland bröstcancerpatienter vad gäller information, stöd, bemötande och delaktighet i samband med återbesöket hos kontaktsjuksköterskan efter bröstkirurgi. Äldre kvinnor var mer nöjda med informationen jämfört med de yngre. Utbildningsnivå hade ingen betydelse för hur nöjd patienten var eller uppfattningen av delaktighet och stöd. Inte heller kunde man påvisa några signifikanta skillnader mellan information och delaktighet mellan de som genomgått bröstbevarande kirurgi kontra tagit bort hela bröstet. Slutsats Kontaktsjuksköterskan har således en viktig roll på mottagningen när det gäller omvårdnad och vårdkvalitet ur ett patientperspektiv. Att kunna identifiera områden som är i behov av förbättring är viktigt. Analysen ger stöd för att det arbetssätt som kontaktsjuksköterskorna och läkarna har idag är positivt för patienten då studien påvisade att majoriteten av patienterna var mycket nöjda med information, stöd, bemötande och kände sig delaktiga vid sitt återbesök hos kontaktsjuksköterska. Nyckelord: Stöd, bemötande, information, patientdelaktighet, bröstcancer patienter. / ABSTRACT Background When a cancer diagnosis is given much information that cause psychological reactions. To provide individual support, information and good treatment is important for the patient to feel confident and involved in their care. Aim To evaluate breast cancer patient's experience of information, support, treatment and involvement during her visits at the contact nurse after surgery at the outpatient clinic. Method A cross-sectional study with a quantitative approach when the main focus was the patient's experience of information, support, treatment and participation. The patients were asked to answer an electronic questionnaire directly after her return visit to the clinic. In total, 48 patients participate in the survey. Results The results showed a very high degree of satisfaction among breast cancer patients in terms of information, support, treatment and participation in connection with the return visit of the contact nurse after breast surgery. Older women were more satisfied with the information compared to younger women. Level of education had no impact on how satisfied patients were or perceptions of participation and support.  There were no significant changes concerning information and participation from those who have undergone breast conserving surgery versus removal of the entire breast. Conclusion The contact nurse plays an important role on reception when it comes to care and quality of care from a patient perspective. To identify areas in need of improvement is important. The analysis provides support for the work procedure that the contact nurses and doctors today are positive using for the breast cancer patients. The study demonstrated that the majority of patients were very satisfied with the information, support, and treatment and felt involved in the visit of the contact nurse. Keyword: Support, treatment, information, patient involvement , breast cancer patients.

In the treatment of early stage breast cancer, both mastectomy and lumpectomy followed by radiation therapy have been recognized as having similar survival rates. Increasingly, women are being given the opportunity to choose which of these surgical treatment options they wish to pursue. Decisions tend to be made rather quickly, and some women may later regret their treatment choice. In this study, an instrument (Breast Cancer Treatment Inventory (BCTI)) was developed that identified five primary sources of influence that affect women's breast cancer treatment decisions: cosmetic outcome, preparedness, physician's choice, short-term effects, and long-term effects. Items were generated and refined by oncology professionals and breast cancer survivors, followed by a pilot study conducted with members of a breast cancer support group. The resulting 28-item scale was completed by 139 early stage breast cancer patients. A series of oblique factor analyses yielded a five-factor solution with reliabilities ranging from .66 - .87. Content validity was enhanced by involving oncology experts and women with breast cancer in the item generation procedures. Use of the BCTI may assist women through a methodical and effective decision-making process. The BCTI may also be appropriate for research studiesinvolving the process and prediction of treatment selection since it meets requirements for ease of administration, brevity, reliability, and validity. / Department of Counseling Psychology and Guidance Services

The purpose of this study was to explore the marital adjustment of older adult couples with breast cancer, prostate cancer, and couples who have experienced neither. Participants were 64 couples in which at least one of the spouses was over 55 years of age, including 19 breast cancer couples, 20 prostate cancer couples, 25 couples who had experienced neither of these cancers. Most participants were young-old, Protestant, Caucasians from a high socioeconomic class. The breast cancer and prostate cancer participants had completed treatment an average of 39.5 months prior to participation. The methodology was a mail survey. Participants completed a demographic questionnaire, the Marital Satisfaction Questionnaire for Older Adults (MSQFOP) (Haynes et al., 1992), Primary Communication Inventory (PCI) (Navran, 1967), Miller Social Intimacy Scale (MSIS) (Miller & Lefcourt, 1982), and the Index of Sexual Satisfaction (ISS) (Hudson et al., 1981).There were no differences in the amount of discordance between the couples groups' level of marital satisfaction, communication, intimacy, and sexual satisfaction. In addition, there were no differences in the level of marital satisfaction, communication, intimacy, and sexual satisfaction between the participant groups. There was a significantly greater correlation between the prostate cancer couples' scores on the ISS than the correlation between the breast cancer couples' scores and the scores of the couples who had not experienced breast cancer or prostate cancer.The level of marital satisfaction, communication, intimacy, and sexual satisfaction reported was similar to that of the normative samples. There was no difference between the marital adjustment of the cancer couples and older couples who had experienced neither type of cancer. These results are good news for breast and prostate cancer survivors, and professionals. Older adults may be better able to incorporate the experience of cancer into their lives or are better prepared for chronic illness through anticipatory socialization. The high degree of agreement between the prostate cancer spouses on the ISS may be related to the sexual dysfunction that frequently accompanies treatment for this cancer. Future research should be qualitative and longitudinal and continue to explore the psychosocial implications of prostate cancer. / Center for Gerontology

M.A. / It is well known that high levels of anxiety and/or depression often accompany the diagnosis and treatment of breast cancer. Literature from various sources, but in particular from the fairly new field of research, Psychoneuroimmunology, also provides ample evidence that excessive anxiety and/or depression can be immunosuppressive. It makes sense, therefore, that any intervention restoring balance to the immuno-regulatory system, thereby allowing the body’s innate healing processes to focus on eliminating cancer, is highly desirable. In line with current thinking based on the mind-body connection as well as cognitive behavioural techniques utilised in many therapeutic settings, various psychological interventions have been found to help the patient gain a better sense of control over distressing symptoms and side-effects of cancer. Some of these include: basic cognitive restructuring, hypnotherapy, relaxation-meditation techniques, art and music therapy, and guided imagery. Substantial international research was found illustrating the beneficial affect that the psychological intervention, guided imagery, provided in such diverse settings including work, sport and health. In this regard, it was decided to run a pilot study to ascertain whether a specifically designed tape recording with relaxing music and dialogue aimed at helping patients manage and cope with negative symptoms of cancer, could significantly reduce anxiety and/or depression levels in women with breast cancer. To operationalise the above, 40 women, aged between 30 and 60, with Stages 1, 2 or 3 breast cancer, who are about to commence adjunctive chemotherapy, were randomly selected to a treatment and a control group. A quasi-experimental design was applied to this study whereby the treatment group was subjected to pre- and post chemotherapy Hospital Anxiety & Depression (HAD) Scale and blood pressure measurements on their 1st, 3rd and final cycle of treatments. The HAD Scale is a well-researched and respected, quick, self-diagnostic assessment utilised abroad and in this country. The measurement of a person’s blood pressure is provided as a physiological backup to the psychometric assessment of the individual’s anxiety levels. For the intervention, each participant was supplied with her own copy of Healing Imagery for Cancer CD or audiotape, produced by a South African medical doctor, specialising in the “wellness” field. The participant was requested to listen to this tape as often as possible, but particularly during her chemotherapy treatments. The control group was tested pre-1st cycle of chemotherapy and post-6th cycle of chemotherapy. The main hypothesis of this pilot study was that there would be statistically significant decreases in levels of anxiety and depression as a result of the intervention of guided imagery tape recording in women with breast cancer undergoing adjuvant chemotherapy. Statistical analysis of the data revealed that the guided imagery intervention correlated with a decrease in blood pressure (systolic and diastolic) measurements, as well as depression and anxiety over a six-cycle period of chemotherapy. The most significant decrease was correlated with the anxiety variable. This pilot study revealed some methodological weaknesses but at the same time results are sufficiently encouraging to warrant further in-depth research regarding the use of guided imagery as a cost-effective, relatively easy method for individuals with cancer to learn and utilise as part of their integrative treatment regimen.

Please read the abstract (Summary) in the section, 00front, of this document / Thesis (PhD (Psychology))--University of Pretoria, 2008. / Psychology / PhD / unrestricted

Indiana University-Purdue University Indianapolis (IUPUI) / Photographs invite women to construct their own meanings of the self and illness without boundaries of race, ethnicity, and culture differences. This study analyzed 15 intensive interviews with 15 Asian (Thai) women in Thailand. The results are divided into two parts. In part I, grounded theory analyses revealed four major themes of experiences of Asian (Thai) female breast cancer survivors, including: (1) experiencing uncertainty of signs and symptoms, (2) entering the medical establishment, (3) experiencing self-change after treatment, and, (4) desiring to return to normality. In part II, the 15 women were shown a postmodern artistic photo book of American women who have breast cancer. The goal was to assess how they related to American women faced with their own stories of breast cancer. The results of the postmodern artistic photo book showed that Asian (Thai) women narrated their illness experiences in both modern and postmodern ways. This study not only revealed the sociological perspectives of Asian (Thai) women who suffered from breast cancer as they experienced a four-stage process, but enhanced our understanding of how disease experiences are socially constructed. In addition, this study provides an opportunity for medical systems in both the East and the West to use postmodern artistic photo books of women with breast cancer for forging ties with others, including patients, patients’ families, hospitals, and caregivers.

Indiana University-Purdue University Indianapolis (IUPUI) / Psychological and marital adjustment are two important outcomes for patients with breast cancer. Personality traits, such as hope and optimism, may influence adjustment to adversity. It was hypothesized that patient and partner hope and optimism would differentially predict patient marital and psychological adjustment. Measured variable path analysis with 56 patient-partner dyads found that patient and partner hope equally predict patient marital adjustment, while there was a trend for patient optimism predicting patient psychological adjustment. These results suggest that hope and optimism differentially predict adjustment outcomes, and that the partner also has a role in the patients’ adjustment. Regression analyses were used to examine the hypothesis that discrepancies in patient and partner personality would result in maladjustment. No interaction effects were found predicting patient psychological adjustment. Three out of six interactions were found for patient marital adjustment. These analyses suggest that complementary personality styles among couples coping with breast cancer may result in optimal patient marital adjustment.