Roanne Thomas-MacLean

Arm morbidity and disability after breast cancer: new directions for care.

PURPOSE/OBJECTIVES To chart the incidence and course of three types of arm morbidity (lymphedema, pain, and range of motion [ROM] restrictions) in women with breast cancer 6-12 months after surgery and the relationship between arm morbidity and disability. DESIGN Longitudinal mixed methods approach. SETTING Four sites across Canada. SAMPLE 347 patients with breast cancer 6-12 months after surgery at first point of data collection. METHODS Incidence rates were calculated for three types of arm morbidity, correlations between arm morbidity and disability were computed, and open-ended survey responses were compiled and reviewed. MAIN RESEARCH VARIABLES Lymphedema, pain, ROM, and arm, shoulder, and hand disabilities. FINDINGS Almost 12% of participants experienced lymphedema, 39% reported pain, and about 50% had ROM restrictions. Little overlap in the three types of arm morbidity was observed. Pain and ROM restrictions correlated significantly with disability, but most women did not discuss arm morbidity with healthcare professionals. CONCLUSIONS Pain and ROM restrictions are prevalent 6-12 months after surgery, but lymphedema is not. Pain and ROM restrictions are associated with disability. IMPLICATIONS FOR NURSING Screening for pain and ROM restrictions should be part of breast cancer follow-up care. Left untreated, arm morbidity could have a long-term effect on quality of life. Additional research into the longevity of various arm morbidity symptoms and possible interrelationships also is required.

Predictors of arm morbidity following breast cancer surgery

Objective: Arm morbidity post‐breast cancer surgery is increasingly being recognized as a chronic problem for some women following breast cancer surgery. The purpose of this study was to examine demographic, disease, and treatment‐related predictors of a comprehensive array of chronic arm morbidity (pain, lymphedema, functional disability, and range of motion) post‐breast cancer surgery.

Physicians’ Constructions of Depression: Inside/Outside the Boundaries of Medicalization

A qualitative study explored primary care physicians’ experiences of diagnosing and treating depression. Twenty physicians participated in semi-structured interviews. Interview questions asked physicians to consider a range of topics such as the etiology of depression, the diagnostic process and treatment of depression. Transcripts were analyzed discursively with a view to exploring the ways in which physicians construct depression. In this article, physicians’ constructions of depression are examined through exploration of their descriptions of this condition, as well as their recognition of the social context of depression. Based on this analysis, it was concluded that physicians’ medicalized understandings of depression conflict with recognition of the social context of depression. The result of this conflict is dissonant descriptions of depression. One implication of this research is that physicians’ training would benefit from the integration of multidisciplinary perspectives on depression, which would better reflect physicians’ experiences in routine practice situations.

Creating Collaborative Visions with Aboriginal Women: A Photovoice Project

This chapter provides a critical appraisal of cross-cultural research, using the photovoice method with Aboriginal women. Photovoice is defined as a participatory action research method, as well as a process towards health promotion. Participants take pictures to document their realities and engage in critical reflection individually and in a group process, using images and stories to advocate community and policy changes. This chapter focuses on some of the methodological challenges and accomplishments associated with photovoice and our project entitled Visualizing Breast Cancer. Our participants were 12 Aboriginal survivors of Breast Cancer from Saskatchewan, Canada. We discuss our collective successes as well as some of the responsibilities and risks of conducting research with Aboriginal women, including recruitment, participation, retention, community-building, advocacy and ethics. Interpretive boundaries and the “truths” of qualitative research (relative to the research setting) add a further appraisal of the complexities of this type of qualitative research and the powerful lessons of research and unplanned happenings.