Women diagnosed with breast cancer and who have the disease surgically treated by
mastectomy experience a health crisis. This thesis focused on the behaviours, feelings
and attitudes of women during their breast cancer and mastectomy experiences. The
overall purpose was to identify therapeutic factors that can be used by health
professionals to improve the psychological and physiological well-being of women with
this disease. The conceptual scaffolding for the thesis was drawn from the fields of
perceptual psychology and decision-making.
The thesis was supported by a study that examined specific areas concerning the breast
cancer and mastectomy experience. These areas were self-perceptions, the
psychological milieu resulting from a breast cancer diagnosis, and post-mastectomy
breast restoration decision-making. The population included: a prosthesis group of 64
women who had mastectomies and wore external breast prostheses, a reconstruction
group of 31 women who had mastectomies and underwent breast reconstructions, a
control A group of 75 women who had not experienced mastectomy, and a control B
group of 65 women who also had not experienced mastectomy.
Self-perceptions:
The perceptions of the prosthesis, reconstruction and control A groups regarding their
body-image, self-concept, total self-image, and self-esteem were compared by using
Polivy's (1977) Body-Image Scale and Rosenberg's (1965) Self-Esteem Scale. The
body-image, total self-image, and self-esteem mean scores indicated that the prosthesis
and reconstruction groups had more positive feelings regarding their bodies than did the
control group. There were no significant differences in self-concept among the three
groups. These findings challenge a common assumption that mastectomy automatically
results in psychiatric morbidity caused by an altered body-image and suggest that health
professionals should not make assumptions about how a woman will psychologically
respond to mastectomy.
Quality of life perceptions were compared among the prosthesis, reconstruction and
control B groups using the Ferrans and Powers (1985) Quality of Life Index. The mean
scores of the prosthesis and reconstruction groups were higher than the control group's
scores, with higher scores indicating more positive quality of life perceptions. The
findings suggest that the women in the mastectomy samples had found ways to cope
with their health crises. Over time, they learned not to define all existence in terms of a
cancer diagnosis and had gained or maintained a positive perspective on life.
Post-mastectomy attitudes in the prosthesis and the reconstruction groups were
compared. Using the Mastectomy Attitude Scale the results indicated that both groups
were satisfied with their bodies, had a positive outlook towards their lives, implied that
sexuality entailed more than having breasts, and felt that mastectomy treatment was
necessary to save their lives. Neither group concealed that they had a mastectomy, nor
were the women prone to discuss their mastectomy experiences. The findings from the
study indicate that the women post-mastectomy already had or developed positive
attitudes towards themselves and life in general and the method chosen for breast
restoration had no apparent impact on these attitudes.
The self-perception data indicated that women do adjust and cope with breast cancer
surgically treated by mastectomy. These women should be encouraged by health
professionals to develop a helping relationship with other women who are newly
diagnosed with the disease. This alliance could engender hope in those women who are
beginning their journey along a similar road to survival. More hope for these women
and less fatalism would decrease their sense of crisis and facilitate their abilities to take
an active part in the decision-making processes relating to their treatment.
Psychological Milieu:
The women in the prosthesis and the reconstruction groups were interviewed about their
breast cancer and mastectomy experiences. The findings supported the premise that
receiving a diagnosis of breast cancer plunged the women into a health crisis and caused
an instant disruption to their lives. The women found that they had to suddenly deal
with several complex issues all at the same time, such as what must be done in the
immediate future to treat the cancer, as well as the more frightening issues of the
meaning of the illness on their ultimate life expectancy. All of this turmoil played
havoc with their ability to make informed decisions regarding their breast cancer
treatment alternatives. This finding suggests the need for more individualised
interventions and support for women when they are making decisions during this
stressful period. Health professionals need to keep in mind that simply hearing the
word "cancer" often prevents a person from assimilating the complete diagnosis,
indicated treatments, and possible prognosis. Therefore, care-givers must be prepared
to repeat and elaborate upon information previously given to the affected individual and
the family.
Breast Restoration Decision-Making:
To evaluate the prosthesis and the reconstruction groups' abilities to undertake
competent breast restoration decision-making, a 5 Stage process was devised, modelled
after Janis and Mann's (1977) seven criteria for competent decision-making. Analysis
of the data revealed that both groups displayed passive information seeking behaviour
in relation to breast restoration alternatives. They had either no knowledge or limited
knowledge regarding the alternatives. Their lack of knowledge was due either to (1)
anxiety about their disease, or (2) deficiencies in the interpersonal skills of individuals
presenting information to them, or (3) the perceptions that they had insufficient time to
gather information, or (4) a combination of these factors.
Because the prosthesis and the reconstruction groups were under stress they used coping
styles to accomplish decision-making. To measure their coping styles five categories
were defined, based on Janis and Mann's (1977) conflict model of emergency decisionmaking
and Simon's (1957) notion of "bounded rationality". Two styles emerged. The
prosthesis group used the "Sideliner" style that allowed the women to make a quick,
conflict-free decision. They were not aware of alternative choices resulting in their
decision-making experience being uncomplicated and effortless. The reconstruction
group used the "Contented" style that also allowed them an uncomplicated and
effortless decision-making experience. The women decided that breast reconstruction
was their only viable option. Many of them did not even think that they had made a
decision about an alternative because of the strong salience towards breast
reconstruction.
A breast restoration decision-making model has been developed and proposed for
women to use when considering their alternatives. This model offers to health
professionals and women a realistic and useable decision-making process that can be
implemented when individuals are experiencing a health crisis. The model can be
modified and used for numerous situations that require decisions regarding treatment
alternatives.
This inquiry has demonstrated that there is a need for a specific health professional to
assist women newly diagnosed with breast cancer. This individual would assume
several roles that include one of advocacy for the women, and the important role of
ensuring that these individuals have the information and knowledge to make competent
decisions regarding their breast cancer treatments.
| Identifer | oai:union.ndltd.org:ADTP/219507 |
| Date | January 1996 |
| Creators | Lewis Reaby, Linda, n/a |
| Publisher | University of Canberra. Applied Science |
| Source Sets | Australiasian Digital Theses Program |
| Language | English |
| Detected Language | English |
| Rights | ), Copyright Linda Lewis Reaby |
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