Helen Beesley

‘You're putting thoughts into my head’: a qualitative study of the readiness of patients with breast, lung or prostate cancer to address emotional needs through the first 18 months after diagnosis

To investigate the readiness of patients to address emotional needs up to 18 months following a diagnosis of breast, lung or prostate cancer.

Anger and childhood sexual abuse are independently associated with irritable bowel syndrome

OBJECTIVES Irritable bowel syndrome (IBS) presents in the absence of identifiable organic pathology. Clinical and research literature has suggested that both childhood abuse and anger are linked to functional gastrointestinal conditions including IBS. The present study tested the predictions that IBS patients, when compared to patients with an organic bowel disease (Crohns disease), have higher levels of trait and suppressed anger, and that these mediate the link between abuse and IBS. DESIGN The study was a cross-sectional multivariate comparison between groups of patients with IBS and Crohns disease. METHOD Levels of self-reported trait and suppressed anger and recalled childhood abuse in patients with IBS (N=75) or Crohns disease (N=76) were compared, using self-report questionnaires and controlling for other psychological characteristics (anxiety, depression, and dissociation). RESULTS Trait and suppressed anger were greater in IBS patients, and differences in trait anger remained significant after controlling for other psychological variables. Childhood sexual abuse was more prevalent in IBS than Crohns disease patients but was unrelated to trait anger. CONCLUSIONS Higher levels of anger characterize IBS patients when compared to an organic bowel disease group, but do not explain the link between childhood abuse and IBS.

How do women at increased breast cancer risk perceive and decide between risks of cancer and risk-reducing treatments? A synthesis of qualitative research

Risk‐reducing procedures can be offered to people at increased cancer risk, but many procedures can have iatrogenic effects. People therefore need to weigh risks associated with both cancer and the risk‐reduction procedure in their decisions. By reviewing relevant literature on breast cancer (BC) risk reduction, we aimed to understand how women at relatively high risk of BC perceive their risk and how their risk perceptions influence their decisions about risk reduction.

Qualitative analysis of how patients decide that they want risk-reducing mastectomy, and the implications for surgeons in responding to emotionally-motivated patient requests

Objective Contemporary approaches to medical decision-making advise that clinicians should respect patients’ decisions. However, patients’ decisions are often shaped by heuristics, such as being guided by emotion, rather than by objective risk and benefit. Risk-reducing mastectomy (RRM) decisions focus this dilemma sharply. RRM reduces breast cancer (BC) risk, but is invasive and can have iatrogenic consequences. Previous evidence suggests that emotion guides patients’ decision-making about RRM. We interviewed patients to better understand how they made decisions about RRM, using findings to consider how clinicians could ethically respond to their decisions. Methods Qualitative face-to-face interviews with 34 patients listed for RRM surgery and two who had decided against RRM. Results Patients generally did not use objective risk estimates or, indeed, consider risks and benefits of RRM. Instead emotions guided their decisions: they chose RRM because they feared BC and wanted to do ‘all they could’ to prevent it. Most therefore perceived RRM to be the ‘obvious’ option and made the decision easily. However, many recounted extensive post-decisional deliberation, generally directed towards justifying the original decision. A few patients deliberated before the decision because fears of surgery counterbalanced those of BC. Conclusion Patients seeking RRM were motivated by fear of BC, and the need to avoid potential regret for not doing all they could to prevent it. We suggest that choices such as that for RRM, which are made emotionally, can be respected as autonomous decisions, provided patients have considered risks and benefits. Drawing on psychological theory about how people do make decisions, as well as normative views of how they should, we propose that practitioners can guide consideration of risks and benefits even, where necessary, after patients have opted for surgery. This model of practice could be extended to other medical decisions that are influenced by patients’ emotions.

Breast Cancer Survivorship: Psychological Distress, Body Image, Sexuality and Importance of the Clinical Consultation

More women are becoming cancer «survivors». The side effects of treatment, and the existential threat of cancer, can have physical and psychological consequences. Psychological distress is a natural response to breast cancer and can dissipate over time. However, clinically significant levels of depression and anxiety are common. Two specific patient factors are discussed in more detail which can increase the likelihood of significant distress, poor body image and childhood adversity, although other factors are also important (e.g. fear of recurrence). The proposed mechanisms by which childhood adversity might affect adjustment to breast cancer, and ability to be supported by the clinical team, are described. There follows a discussion of some key findings from research investigating the factors patients find helpful in the contact they have with clinicians involved in their care.