Robin M. Lally

Quality of life after breast carcinoma surgery: a comparison of three surgical procedures.

Because breast‐conserving surgery (BCS), mastectomy alone, and mastectomy with reconstruction are equally effective for the treatment of early stage breast carcinoma, womens choice among them often focuses on quality‐of‐life (QOL) issues. Information regarding QOL after these surgical treatments could help women with this decision.

Axillary disease recurrence after sentinel lymph node dissection for breast carcinoma

Surgical recommendation for early‐stage breast carcinoma includes removal of the primary breast tumor and evaluation of the axillary lymph nodes on the ipsilateral side. Sentinel lymph node dissection (SLND) is increasingly being used to evaluate axillary lymph nodes in clinically lymph node negative patients as an alternative to axillary lymph node dissection (ALND). Results from SLND are highly predictive of metastatic involvement in the axilla, and are associated with fewer side effects. However, the greatest concern with SLND alone is the potential for a higher rate of axillary lymph node recurrence. The purpose of the current study was to review data collected on 700 consecutive patients with early‐stage breast carcinoma who underwent SLND without concomitant ALND.

In the Moment: Women Speak About Surgical Treatment Decision Making Days After a Breast Cancer Diagnosis

PURPOSE/OBJECTIVES To explore the pretreatment thoughts and behaviors of women newly diagnosed with breast cancer regarding their surgical treatment decision-making experience. RESEARCH APPROACH Qualitative, descriptive. SETTING A multispecialty breast center in the midwestern region of the United States. PARTICIPANTS 18 English-speaking women, aged 37-87 years, mean of 12 days postdiagnosis of clinical stage 0-11 breast cancer. METHODOLOGIC APPROACH Open to semistructured interviews were conducted during the period following surgical consultation but prior to surgical treatment. Transcribed interviews, originally analyzed to identify the psychological processes of women in response to breast cancer diagnosis, were additionally analyzed using directed content analysis focusing on womens thoughts and behaviors related to their surgical treatment decision-making process. MAIN RESEARCH VARIABLES Breast cancer surgery and decision making pretreatment. FINDINGS Womens pretreatment thoughts and behaviors related to surgical treatment decision making were characterized by information processing, contemplating options, and interacting with others. Breast cancer information was used by women before the surgical consultation and after treatment decisions had been made. Treatment options were contemplated and preferences formed often before the initial surgical consultation. Women associated having options with a better prognosis. Age was a factor primarily in the type of information women desired. CONCLUSIONS Most women made their own surgical treatment decisions with ease, supported by the confidence instilled by their surgeons and oncology nurses. INTERPRETATION The findings provide oncology nurses with insight regarding womens desire for and use of information and their contemplation of surgical options, therefore suggesting areas on which to focus clinical assessment and to test tailored interventions.

Influence of Demographic Factors, Knowledge, and Beliefs on Jordanian Women's Intention to Undergo Mammography Screening

PURPOSE The purpose of this study was to determine the influence of demographic characteristics, breast cancer knowledge, fatalistic beliefs, health beliefs, and subjective norms on Jordanian womens intention to participate in mammography screening. DESIGN A cross-sectional survey was used to collect data at 14 comprehensive healthcare centers in Amman and Zarqa, Jordan. A convenience sample of 142 Jordanian women 40 years of age or older with no history of breast cancer and able to read and write in Arabic participated. METHODS Self-report surveys included a combination of researcher-designed and existing instruments to measure the study variables. Data were analyzed using descriptive statistics, Pearsons correlation, t tests, and multiple logistic regression. FINDINGS Jordanian women surveyed lacked knowledge about breast cancer. Social norms and self-efficacy highly influenced these womens intention to engage in mammography screening. Younger women were more willing to indicate intention to engage in mammographic screening. CONCLUSIONS Self-efficacy and the social connectedness of Jordanian society, but not religious beliefs or perceived barriers to screening, influence Jordanian womens intention to undergo mammography. Future research should examine cultural influences, rather than religious beliefs, and investigate Jordanian womens potentially unique perspectives on barriers to actual mammography screening behavior. CLINICAL RELEVANCE The prevalence of mammography screening may be enhanced by focusing interventions on Jordanian womens support systems and empowering women by providing knowledge and skills needed to engage in the procedure.

Shared Decision Making Among Individuals With Cancer in Non-Western Cultures: A Literature Review

PURPOSE/OBJECTIVES To examine the extent to which shared decision making is a concept addressed within the published, empirical oncology decision-making research originating from non-Western countries from January 2000 to January 2012 and provide an overview of the outcomes of this research. DATA SOURCES MEDLINE®, CINAHL®, Google Scholar, PsycINFO, Web of Science, and PubMed were searched for oncology decision-making literature published in English from January 2000 to January 2012. DATA SYNTHESIS Charless three-stage conceptual framework of shared decision making was used as an organizational framework for the 26 articles meeting the initial criteria and reporting on at least one decision-making stage. CONCLUSIONS Although most patients wanted to be informed of their diagnosis, patient preferences for information and participation in decision making differed from that of physicians and varied among and within cultures. Few studies in this review addressed all three stages of shared decision making. Physician and patient attitudes, preferences, and facilitators and barriers to potential successful adoption of shared decision making in non-Western cultures require additional study. IMPLICATIONS FOR NURSING Nurses should assess patients from non-Western countries regarding their knowledge of and desire to participate in shared decision making and provide decision support as needed. KNOWLEDGE TRANSLATION Shared decision making may be new to patients from non-Western cultures, necessitating assessment, education, and support. Non-Western patients may value having family and friends accompany them when a cancer diagnosis is given, but assumptions based on culture alone should not be made. Nurses should determine patient preferences for diagnosis disclosure, information, and participation in decision making.

Smoking behavior and patient education practices of oncology nurses in six countries

Worldwide, tobacco is the leading cause of preventable death, resulting in approximately 5 million deaths annually. Nurses are keenly positioned to work toward reducing tobacco-related illness and deaths. Therefore, guided by the health belief model, the purpose of this study was to explore the smoking behavior, beliefs, smoking cessation education practices, and existing smoking policies at the institutions of a sample of practicing oncology nurses in Canada, Japan, Korea, Taiwan, United Kingdom, and the United States. A 27-item structured survey, designed for this study in English and translated and reverse translated by the Asian countries, was distributed to a convenience sample of nurses attending oncology meetings in each country. Totally 759 surveys were completed and analyzed using descriptive statistics. Principle findings indicate that 4.5% of these nurses currently smoke, although 23.3% reported smoking previously. While many nurses (74%) reported frequently assessing the smoking status of patients, only 50% reported discussing cessation with their patients that smoke. Although the majority (80%) reported feeling comfortable with asking their patients about smoking, only 23% felt it was the nurses role. The findings indicate that while internationally oncology nurses recognize the importance of smoking cessation, significant room for improvement exists in translating this into practice.

Acclimating to breast cancer: a process of maintaining self-integrity in the pretreatment period.

Background:The period between diagnosis and initial treatment is one of the most stressful times for women with breast cancer. Unresolved distress may lead to future mental health and adjustment difficulties. Adjustment is facilitated by thoughts and behaviors that integrate a threatening event into a persons worldview. Few studies, however, have explored womens pretreatment thought processes. Objective:The purpose of this study was to develop a grounded theory of the pretreatment thought processes and behaviors of women diagnosed with breast cancer. Methods:Grounded theory method guided theoretical sampling of 18 women from a Midwestern, US breast center who were 37 to 87 years old, diagnosed with stage 0 to II breast cancer within the past 6 to 21 days and awaiting surgical treatment. Constant comparison of interview data and open, selective, and theoretical coding identified interrelated concepts and constructs that formed the grounded theory. Results:Threatened self-integrity was the main concern of women identified in the pretreatment period. Women addressed this problem through a continuous, nonlinear process of acclimating to breast cancer consisting of 3 stages: surveying the situation, taking action, and emerging self. Situational and personal factors influenced womens degree of engagement in 1 or more stages. Conclusions:Womens pretreatment response to breast cancer diagnosis involves integrated thought processes to maintain self-integrity influenced by situational and personal factors hypothesized to be amenable to interventions that facilitate adjustment. Implications for Practice:New insights provided by this theory can guide clinical practice and generate hypotheses to test pretreatment interventions to support psychological adjustment to breast cancer.

Living my family's story: identifying the lived experience in healthy women at risk for hereditary breast cancer.

Background: Based on known or suggested genetic risk factors, a growing number of women now live with knowledge of a potential cancer diagnosis that may never occur. Given this, it is important to understand the meaning of living with high risk for hereditary breast cancer. Objective: The objective of the study was to explore how women at high risk for hereditary breast cancer (1) form self-identity, (2) apply self-care strategies toward risk, and (3) describe the meaning of care through a high-risk breast program. Methods: Interpretive hermeneutic phenomenology guided the qualitative research method. Women at high risk for hereditary breast cancer were recruited from a high-risk breast program. Open-ended interview questions focused on experiences living as women managing high risk for breast cancer. Consistent with hermeneutic methodology, the principal investigator led a team to analyze the interview transcripts. Results: Twenty women participated in in-depth interviews. Analysis revealed that women describe their own identity based on their family story and grieve over actual and potential familial loss. This experience influences self-care strategies, including seeking care from hereditary breast cancer risk experts for early detection and prevention, as well as maintaining a connection for early treatment “when” diagnosis occurs. Conclusions: Healthy women living with high risk for hereditary breast cancer are living within the context of their family cancer story, which influences how they define themselves and engage in self-care. Implications for Practice: Findings present important practical, research, and policy information regarding health promotion, psychosocial assessment, and support for women living with hereditary breast cancer risk.

Controlling fear: Jordanian women's perceptions of the diagnosis and surgical treatment of early-stage breast cancer.

Background: Despite the fact that breast cancer is the most prevalent cancer among Jordanian women, practically nothing is known about their perceptions of early-stage breast cancer and surgical treatment. Objective: The objective of this study was to gain understanding of the diagnosis and surgical treatment experience of Jordanian women with a diagnosis of early-stage breast cancer. Methods: An interpretive phenomenological approach was used for this study. A purposive sample of 28 Jordanian women who were surgically treated for early-stage breast cancer within 6 months of the interview was recruited. Data were collected using individual interviews and analyzed using Heideggerian hermeneutical methodology. Results: Fear had a profound effect on Jordanian women’s stories of diagnosis and surgical treatment of early-stage breast cancer. Women’s experience with breast cancer and its treatment was shaped by their preexisting fear of breast cancer, the disparity in the quality of care at various healthcare institutions, and sociodemographic factors (eg, education, age). Conclusions: Early after the diagnosis, fear was very strong, and women lost perspective of the fact that this disease was treatable and potentially curable. To control their fears, women unconditionally trusted God, the healthcare system, surgeons, family, friends, and/or neighbors and often accepted treatment offered by their surgeons without questioning. Implications for Practice: Jordanian healthcare providers have a responsibility to listen to their patients, explore meanings they ascribe to their illness, and provide women with proper education and the support necessary to help them cope with their illness.

Exploring the first days of adjustment to cancer: a modification of acclimating to breast cancer theory.

Background:Psychological adjustment may not be achieved by some women even years after breast cancer diagnosis. Although level of adjustment to diagnosis in the earliest (pretreatment) period is associated with future adjustment, limited research has explored this early period. Greater knowledge of women’s thoughts and behaviors as adjustment is initiated is needed to target interventions for women at risk for future adjustment problems. Objectives:This study was intended to expand what is known about the pretreatment experiences, thought processes, and behaviors of women diagnosed with breast cancer and further define concepts and increase the scope of Acclimating to Breast Cancer, a grounded theory of adjustment in the pretreatment period. Methods:Forty-five semistructured interviews were conducted with 26 women prior to and again within 30 days after breast cancer surgery. Women were 39 to 81 years old with stage 0 to stage II disease and primarily varied from the original sample geographically and on length of, and care coordination during, the pretreatment period. A multidisciplinary team performed directed content analysis, comparing new data to the original theory. Results:Although generally consistent with the original theory, findings contributed to renaming 1 and adding 2 theory categories plus expanding 7 of 8 existing categories. Additional personal and situational influences on the process were identified. Conclusion:The grounded theory of Acclimating to Breast Cancer was modified with new data from women currently experiencing the pretreatment period following diagnosis. Implications for Practice:This theory modification provides a framework to guide needed assessment, psychoeducation, and research aimed at supporting psychological adjustment during the pretreatment period.