Kerry A. Sherman

My changed body: breast cancer, body image, distress and self-compassion

Bodily changes after breast cancer treatment can lead to long‐term distress. Self‐compassion, the ability to be kind to oneself, is an internal resource that may enhance a womans ability to adjust to cancer‐related bodily changes. The aim of the present study was to test the hypothesis that self‐compassion mediates the relationship between body image and distress, controlling for alternate plausible mediators.

Communication strategies for enhancing understanding of the behavioral implications of genetic and biomarker tests for disease risk: The role of coherence

Individuals frequently have difficulty understanding how behavior can reduce genetically-conferred risk for diseases such as colon cancer. With increasing opportunities to purchase genetic tests, communication strategies are needed for presenting information in ways that optimize comprehension and adaptive behavior. Using the Common-Sense Model, we tested the efficacy of a strategy for providing information about the relationships (links) among the physiological processes underlying disease risk and protective action on understanding, protective action motivations, and willingness to purchase tests. We tested the generalizability of the strategy’s effects across varying risk levels, for genetic tests versus tests of a non-genetic biomarker, and when using graphic and numeric risk formats. In an internet-based experiment, 749 adults from four countries responded to messages about a hypothetical test for colon cancer risk. Messages varied by Risk-Action Link Information (provision or no provision of information describing how a low-fat diet reduces risk given positive results, indicating presence of a gene fault), Risk Increment (20%, 50%, or 80% risk given positive results), Risk Format (numeric or graphic presentation of risk increments), and Test Type (genetic or enzyme). Providing risk-action link information enhanced beliefs of coherence (understanding how a low-fat diet reduces risk) and response efficacy (low-fat diets effectively reduce risk) and lowered appraisals of anticipated risk of colon cancer given positive results. These effects held across risk increments, risk formats, and test types. For genetic tests, provision of risk-action link information reduced the amount individuals were willing to pay for testing. Brief messages explaining how action can reduce genetic and biomarker-detected risks can promote beliefs motivating protective action. By enhancing understanding of behavioral control, they may reduce the perceived value of genetic risk information.

Regret associated with the decision for breast reconstruction: The association of negative body image, distress and surgery characteristics with decision regret

This study investigated the influence of psychosocial and surgical factors on decision regret among 123 women diagnosed with breast cancer who had undergone immediate (58%) or delayed (42%) breast reconstruction following mastectomy. The majority of participants (52.8%, n = 65) experienced no decision regret, 27.6% experienced mild regret and 19.5% moderate to strong regret. Bivariate analyses indicated that decision regret was associated with negative body image and psychological distress – intrusion and avoidance. There were no differences in decision regret either with respect to methods or timing patterns of reconstructive surgery. Multinominal logistic regression analysis showed that, when controlling for mood state and time since last reconstructive procedure, increases in negative body image were associated with increased likelihood of experiencing decision regret. These findings highlight the need for optimal input from surgeons and therapists in order to promote realistic expectations regarding the outcome of breast reconstruction and to reduce the likelihood of women experiencing decision regret.

Computerised decision aids: a systematic review of their effectiveness in facilitating high-quality decision-making in various health-related contexts.

OBJECTIVE To systematically review existing empirical evidence regarding the effectiveness of computerised decision aids (CDAs) in enabling high-quality decision-making in preference-sensitive health-related contexts. METHODS Relevant studies were identified via Medline, CINAHL, and PsycINFO databases (1990-October 2010). Only randomised controlled trials with at least one decision quality or decision process variable outcome were included. RESULTS Of 1467 identified articles, 28 studies met all inclusion criteria, evaluating 26 unique CDAs. CDAs performed better than standard consultations/education regarding improved knowledge and lower decisional conflict, and were found not to increase anxiety. CDAs facilitated greater satisfaction with the decision-making process than standard education. The effects on risk perceptions, value congruence with the chosen option, preferred roles in decision-making and decisional self-efficacy need further evaluation. A paucity of CDAs adhered to decision theories. CONCLUSIONS CDAs showed similar effects as non-computerised DAs on various outcomes. Further research into the potentially superior effects of CDAs on feeling informed, values-clarity, and decisional conflict is required. PRACTICE IMPLICATIONS The more remarkable effects on knowledge and risk perceptions were reported when unique features of interactive computerised media were used. The potential benefit of tailored information, values-clarification, and integration of CDAs into shared decision-making consultations remains unresolved.

Rumination, psychological distress and post‐traumatic growth in women diagnosed with breast cancer

Rumination, the repetitive and recursive rehearsal of cognitive content, has been linked to depression and anxiety in physically well populations, and to post‐traumatic growth (PTG) in physical illness populations. Women diagnosed with breast cancer may experience both psychological distress and PTG. As rumination may influence outcomes through distinct pathways, this study investigated the association of intrusion, brooding and instrumental subcomponents of rumination with psychological distress and PTG in the breast cancer context.

Psychosocial predictors of adherence to lymphedema risk minimization guidelines among women with breast cancer

The effective management of lymphedema risk following breast cancer surgery and treatment requires enactment of simple behavioural strategies, including regularly checking for early lymphedema symptoms. Adopting a broad self‐regulatory perspective, our aim for this study was to identify psychological factors associated with adherence to these risk management strategies.

Psychological adjustment among male partners in response to women's breast/ovarian cancer risk: a theoretical review of the literature.

Objective: For women at high risk of developing hereditary breast and/or ovarian cancer the process of undergoing genetic testing is anxiety provoking and stressful, entailing difficult and complex decisions. Partners of high‐risk women are frequently perceived by the women as a source of support during this challenging time. Utilising Self Regulatory Theory, this paper provides a theoretically guided overview of existing data to delineate how partners respond emotionally and behaviourally to the womans high‐risk status.

The Role of Information Sources and Objective Risk Status on Lymphedema Risk-Minimization Behaviors in Women Recently Diagnosed With Breast Cancer

PURPOSE/OBJECTIVES to assess the role of education sources and objective risk status on knowledge and practice of lymphedema risk-minimization behaviors among women recently diagnosed with breast cancer. RESEARCH APPROACH prospective survey. SETTING a hospital in Sydney, Australia. PARTICIPANTS 106 women recently diagnosed with breast cancer at increased risk for developing lymphedema following lymph node dissection. METHODOLOGIC APPROACH a questionnaire administered at the time of surgery and three months after surgery measured demographics, lymphedema knowledge, lymphedema information sources used, and adherence to risk-minimization recommendations. MAIN RESEARCH VARIABLES lymphedema knowledge, source of information used, objective lymphedema risk, and adherence to risk-minimization behaviors. FINDINGS knowledge was high and increased over time. Lymphedema information from the clinic (e.g., brochures, nursing staff) was the most cited source. Adherence to recommendations was moderate; nonadherence was mostly for behaviors requiring regular enactment. Regression analysis revealed that only receipt of information from nursing staff and lymphedema knowledge three months after surgery were significant predictors of risk-minimization behaviors. CONCLUSIONS exposing women to lymphedema risk information at the time of breast cancer diagnosis facilitates increased awareness and enactment of risk-minimization behaviors. Nursing staff play a key role in disseminating this information and in convincing women to perform the recommendations. INTERPRETATION provision of lymphedema education by breast clinic staff is critical to ensure that women realize the importance of early detection and treatment. Reminder booster sessions by nursing staff may be beneficial particularly for longer-term knowledge retention and adherence to recommended behaviors.

Enhanced counselling for women undergoing BRCA1/2 testing: Impact on knowledge and psychological distress–results from a randomised clinical trial

This randomised controlled trial evaluated the impact of an enhanced counselling (EC) intervention on knowledge about the heritability of breast and ovarian cancer and distress, as a function of BRCA test result, among high-risk women. Before deciding about whether or not to undergo genetic testing, participants were randomly assigned to the EC intervention (N = 69), designed to promote cognitive and affective processing of cancer risk information (following the standard individualised counselling session), or to the control condition (N = 65), which involved standard individualised counselling followed by a general health information session to control for time and attention. Women in the EC group exhibited greater knowledge than women in the control group, 1 week after the intervention. Further, at the affective level, the intervention was found to be the most beneficial for women testing positive: specifically 1 week after test result disclosure, women in the intervention group who tested positive experienced lower levels of distress than women in the control group who tested positive. The findings suggest that the design of counselling aids should include a component that explicitly activates the individuals cognitive–affective processing system.

BRECONDA: Development and acceptability of an interactive decisional support tool for women considering breast reconstruction†

Kerry A. Sherman*, Diana M. Harcourt, Thomas C. Lam, Laura-Kate Shaw and John Boyages Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia Westmead Breast Cancer Institute, Westmead Hospital, University of Sydney, Sydney, Australia Centre for Appearance Research, University of the West of England, Bristol, UK Macquarie University Cancer Institute, Sydney, Australia