Maria Papaikonomou

Family history of breast cancer: what do women understand and recall about their genetic risk?

The current study has two aims: (1) to look at peoples recall of risk information after genetic counselling and (2) to determine the impact of receiving an audiotape of the genetic consultation on level of recall, cancer related worry, and womens uptake of risk management methods. Using a prospective randomised controlled design, subjects receiving an audiotape were compared with a standard consultation group. Participants were drawn from attenders at the genetic clinics of two London hospitals and included 115 women with a family history of breast cancer. Assessment of perceived genetic risk, mental health, cancer worry, and health behaviour was made before counselling at the clinic (baseline) and by postal follow up. Usefulness of audiotapes and satisfaction with the clinical service was assessed by study specific measures. The data indicate that cancer worry is reduced by provision of an audiotape of the genetic consultation. Recall of the genetic risk figure, however, is not affected by provision of an audiotape and neither is it related to womens overall perception of being more or less at risk of breast cancer than the average woman. Forty-one percent of women accurately recalled their personal risk of breast cancer at one month follow up; however, 25% overestimated, 11% underestimated, and 23% could not remember or did not know their breast cancer risk. Recall of the risk figure is more accurate when the clinical geneticist has given this to the woman as an odds ratio rather than in other formats. Subsequent health behaviour is unaffected by whether women have an audiotape record of their genetic consultation. Results suggest that having a precise risk figure may be less important than women taking away from the consultation an impression that something can be offered to help them manage that risk. Provision of an audiotape of the consultation is of limited usefulness. The need for psychological care to be better integrated into genetic counselling at cancer family clinics was highlighted by the study. The results are discussed in terms of future service development.

Women Suffering through Their Bodies

This article is concerned with the nature of suffering as experienced by women struggling with problems related to the body. Since the body is viewed as integral in the formation of a womans identity and self-concept, any illness, ailment, or deficiency associated with it may lead her to experience pain and suffering. To explore meanings of personal suffering, three contexts were chosen, namely familial breast cancer, eating disorders, and infertility. A qualitative approach, using the case study method, was adopted to provide rich descriptions of the different experiences of suffering. In-depth interviews were conducted with women living with familial breast cancer, eating disorders, and infertility. Two women were chosen for each context. The results show that for these women suffering manifested as loss, isolation, loneliness, anger, and emptiness. Suffering encompassed the physical, emotional, and social spheres, and entailed a deep and complex experience of pain. It was also evident that suffering remains a personal issue that depends on a persons life circumstances, personality, past and present experiences, the problem at hand, and the surrounding environment.

Narratives on Death and Bereavement From Three South African Cultures: An Exploratory Study

The study aimed to explore how three culturally diverse South African women (n=3) constructed death and bereavement. Data were qualitatively gathered and thematically analyzed. Findings revealed grand narratives (other than western dominance) on death perceptions and bereavement within the Tswana and Islamic Muslim cultures. A westernized perspective played in the Afrikaans culture, much less in the Tswana culture and none in Muslim culture. Further research death and bereavement from other cultural perspectives is needed.

“Complex trauma”: reflections on the effect of early childhood abuse among a small adult group of bariatric patients

The experience of early traumatic exposure, obesity and finally the paradoxical forced behavioural intervention experienced by a small group of five different participants (three women and two men) who underwent bariatric surgery1 to “cure” a chronic disease such as obesity, were explored and structured around the prominent themes identified by the researchers from the “voices” of the participants. The aim was to arrive at a final “voice” that would reflect collectively on their stories. The research question was based on the interrelationship between prolonged traumatic exposures, morbid obesity and whether bariatric surgery acts as a form of remedial intervention for this small group of participants suffering from morbid obesity. A qualitative research paradigm and social constructivist epistemology were supported by the exploratory case study design as a systematic way of collecting data, analysing information through a process of thematic content analysis and finally reporting the results. The delineation of the themes resulted in the following collective sub-themes: Obesity was the result of psychological defences against the impact of prolonged childhood trauma; the symptom constellation of Complex Trauma seems paramount among the participants of this study; and the remedial effect of bariatric surgery on these patients seems complementary to the relief of the impact of early childhood traumatisation. Incidental findings includes: amnesia regarding “good” periods during childhood; obesity creates an “invisible” perception by others of the obese person; to lose weight causes more back pain due to less bodily support by those who had suffered from back pains prior to surgery; while the occurrence of stomach pains after “stressful periods” could be viewed as an unexpected finding from this research group. The research question is based on the interrelationship between prolonged traumatic exposures, morbid obesity and whether the remedial forced behavioural intervention such as bariatric surgery acts as a form of remedial intervention for this small group of participants suffering from morbid obesity.

Rape and Trauma: A Case Study of a Journey of Recovery

This case study presents the results of a counselling intervention with a rape survivor. The woman was twenty-nine years old at the time of the violation. The objective of this study was to explore the dynamics which the woman engaged in coping with the experience of the rape and the resources accessed as part of the healing process. A four leg trauma counselling model is discussed as a short term integrated therapeutic approach. Data was collected and analyzed using a qualitative approach employing a case study method (Terreblanche and Durrheim, 1999), to provide a rich description of the context in which the rape sufferers symptoms were embedded. The results of this study indicate that re-tellings of the trauma narrative may assist post-trauma recovery. The model was experienced as useful in dealing with this rape survivor because of its clear structure which is comprehensive enough to address most of the needs and concerns of trauma survivors.

Childhood cancer: a parent's perspective on social support, with a case illustration.

When a child is diagnosed with cancer, parents enter unfamiliar terrain, where their basic childrearing tasks are challenged. Life changes from diagnosis onwards, through adjustment and then life beyond the illness. Provision of psychological support for the whole family after primary diagnosis is widely considered essential. The objective of this study was to explore a husband and wifes journey of coming to terms with their childs cancer, and to describe resources they used to get through this ordeal. The method used in this study was a case study, using narrative analysis. The positive influence of a social support group is discussed as the main coping mechanism for this family on their path to recovery.

Views of Medical Practitioners and Psychologists on the Inadequacies of the Biomedical Model and the Role of Psychologists in its Extension

Today, health providers are reawakening to the significant role that humanism plays in helping people get well and maintaining a high level of well-being. As medical science has rapidly developed with new drugs, treatments and instruments, there is a genuine concern that the humanistic dimensions of health care have not paralleled these scientific achievements. In this article the author indicates that we are faced with the necessity and the challenge of broadening our approach to disease to include the psychosocial, without sacrificing the enormous advantages of the biomedical model. The results of this study indicated that the majority of medical practitioners in urban and rural areas acknowledge psychologists as having an important role to play within the medical setting. These findings are discussed and the importance of psychosomatic medicine, holism and a multidisciplinary approach towards the treatment of medical disorders is emphasized.

Trauma event autobiographies: An exploratory multiple case study

This multiple case study explored trauma event memories of three individuals to characterise underlying meanings important for their recovery. The three participants were women in the age range of 43 to 54 years old, who shared their own memories of a trauma-laden event four to five years post-occurrence. Thematic analysis of the autobiographical narratives indicated underlying memories across cases of silence imposed on trauma victims by their social environments and communities. Differences in trauma autobiographical memories were in meaning making within the context of the participants’ own culture, society, and community. Autobiographical memory studies appear to have value for understanding likely pathways to recovery from trauma