Su Ying Fang

The effect of breast reconstruction surgery on body image among women after mastectomy: a meta-analysis

The purpose of this study was to analyze the available evidence concerning the effects of breast reconstruction (BR) on body image of women with breast cancer. BR is a potential intervention to improve the body image of women with breast cancer. Conflicting research findings about the effects of breast reconstructive surgery on body image compared to breast conservative surgery (BCS) or mastectomy exist. A meta-analysis of studies found in MEDLINE, CINAHL, PsychINFO, PubMed as well as PQDT (dissertation and theses), and other unpublished literature resources from 1970 to 2010 were searched. Comparable studies that examined the difference of body image between breast cancer women receiving mastectomy plus BR and those with BCS were included. A clear definition about the domains of body image including body stigma, body concern, and transparency were identified. Mean effect sizes were calculated. Twelve studies were included in the meta-analysis. Women with BR and BCS were no different on the body concern domain of body image. However, women with BR had a significantly worse score on body stigma domain of body image than women receiving BCS. Women with BR had a better body image score than women with mastectomy. Women who are satisfied with their body shape may still perceive deficiencies because of the stigma of mastectomy and affect on body image. Consistent application of valid and reliable measures of body image specific to breast cancer women is needed.

Impact of marital coping on the relationship between body image and sexuality among breast cancer survivors

PurposeThe aims of the study were (1) to understand the relationship between women’s marital coping efforts and body image as well as sexual relationships and (2) to test a hypothesized model suggesting that marital coping efforts have a mediating effect on the relationship between body image and sexual relationships among breast cancer survivors.MethodsA total of 135 breast cancer survivors who had finished cancer treatment completed a self-reported questionnaire concerning body image, marital coping efforts, and sexual relationship.ResultsBody image, marital coping, and sexual relationship were found to be significantly correlated with each other. The final path model showed that negative marital coping efforts, including avoidance and self-blame, significantly mediated the effect of women’s body image on their sexual relationships. Although a positive approach did not correlate with body image, it did significantly correlate with women’s sexual relationships.ConclusionsOur study demonstrated that negative marital coping using self-blame and avoidance mediated the association between body image and sexual relationship. Future interventions to address the body image and sexual life of breast cancer survivors should be considered using positive approaches that prevent disengaged avoidance or self-blame coping efforts intended to deal with marital stress.

Objectified Body Consciousness, Body Image Discomfort, and Depressive Symptoms Among Breast Cancer Survivors in Taiwan

The literature comparing the effects of breast reconstructive surgery, breast-conserving surgery, and mastectomy on body image and mental health yields conflicting results. Objectified body consciousness may be a factor that influences the psychological well-being of breast cancer survivors. Women with average time of 19 months from breast cancer surgery were approached in outpatient clinics to participate in our study. Using structural equation modeling, we tested and verified a model that included self-reported objectified body consciousness, cancer-related body image discomfort, and depression among 193 breast cancer survivors in Taiwan. Our results provided support for the hypothesized indirect relation of objectified body consciousness with depression through the mediating role of cancer-related body image discomfort. Specifically, women with higher objectified body consciousness levels reported more cancer-related body image discomfort, which in turn was related to greater depression. Additionally, the degree of this mediation relationship across surgery types was different. These findings are significant to clinicians who should be cognizant of the potential role of objectified body consciousness in promoting cancer-related body image discomfort and depression in breast cancer survivors. Encouraging women to clarify their perceptions of their new bodies and providing care combined with psychological counseling after breast cancer surgery are critical.

Deliberating Over Mastectomy: Survival and Social Roles

Background: Most studies based on a womans decision regarding breast cancer treatments have focused on surgical treatment preference and related factors. Few studies have been carried out to identify the concerns associated with coming to terms with a mastectomy and cancer diagnosis among women eligible for a mastectomy only. Objective: The aim of this study was to explore Taiwanese womens experience about facing a mastectomy and to determine their deliberations before agreeing to a recommended mastectomy. Methods: Ten women who had undergone a mastectomy participated, with 3 undergoing individual interviews and 7 participating in a focus group. Findings during the interviews guided the focus group. Results: Content analysis revealed 4 themes through the womens narratives of the decision-making experience when a mastectomy was recommended. These included (a) surviving is a priority, (b) fulfilling responsibility, (c) coming to terms with postsurgery alternatives, and (d) making arrangements. Conclusion: The experience surrounding the decision to undergo a mastectomy among Taiwanese women may be complicated by survival concerns, the meanings of the breast, and a feeling of an uncontrolled daily life. Cultural beliefs ensured that women were fulfilling their expected social roles and always thinking about significant others first. Implications for Practice: Recognizing womens private concerns with sensitivity and supporting women to balance their own needs and assigned social responsibilities are important considerations for women undergoing a mastectomy. Developing cultural competency is necessary for nurses working in communities with diverse ethnoculture people.

From patient to survivor": Women's experience with breast cancer after 5 years

Background: Women who have survived breast cancer for 5 years without recurrence are not subject to active follow-up because of limited resources. Their life experiences more than 5 years subsequent to diagnosis and treatment are unknown. Objective: The aim of this study was to understand the life experiences and care needs of women who have survived breast cancer for more than 5 years in Taiwan. Methods: A purposive sampling was used. Women diagnosed with breast cancer more than 5 years previously and without recurrence were recruited in this study. The interviews were conducted in a comfortable and convenient place decided by the participants. The interviews were converted into transcripts and analyzed using content analysis. Results: Thirteen women participated in this study whose ages were between 48 and 72 years. Five main themes were identified: (1) fear of recurrence, with women attempting to use ways to reduce recurrence, including dependence on drugs, desire for information, and promoting health; (2) hoping for alleviation of adverse effects; (3) seeking a body image; (4) expectations for the patient-physician relationship; (5) concerns of a mother; and (6) positive thinking. Conclusions: Taiwanese women with post 5-year breast cancer survival continue to have physiological and emotional needs. They long for attention and care from their healthcare team. Implications for Practice: It is pivotal to formulate a care plan suitable for 5-year-plus survivors of breast cancer and to assist them in gaining an understanding of the latest treatments and self-care information. It is crucial that nurses play a greater role in caring for long-term survivors.

The moderating effect of perceived partner empathy on body image and depression among breast cancer survivors.

The aims of the study were the following: (1) to understand the relationship between womens perceptions of empathy from their partners and their depressive symptoms and body image and (2) to examine the moderating effects of womens perceptions of empathy from their partners on the relationship between body image and depressive symptoms.

Validation of the modified Chinese Cancer Survivor's Unmet Needs (CaSUN-C) for women with breast cancer

The aims of the study were to modify the Cancer Survivors Unmet Need (CaSUN) Scale into a short form and then test its psychometric scale‐specific properties for breast cancer survivors in Taiwan.

Gender Difference in Cancer Patients’ Adherence to Analgesics and Related Outcomes of Pain Management

Background: Males and females have significant differences in certain medical outcomes. However, little research has explored the gender differences in cancer patient perceptions of analgesics, the relationship between gender and analgesic adherence, or the effectiveness of pain management. Objective: The objectives of this study were to compare gender differences associated with hesitancy to use analgesics, analgesic adherence, or pain management effectiveness and to examine whether gender can precisely predict analgesic adherence. Methods: The study was conducted in the outpatient oncology department of a medical center in Taiwan. A descriptive and cross-sectional design was used. The study samples were collected from 362 cancer patients. The participants completed the short version of the Barriers Questionnaire–Taiwan, the Morisky Analgesics Adherence Measure–Taiwan version, the Brief Pain Inventory–Chinese version, the Pain Management Index, and a demographic and disease questionnaire. Results: The pain intensity and hesitancy to use analgesics scores were significantly higher among females than among males. The Pain Management Index results indicated that a larger percentage of males had adequate pain management. In addition, being male was a significant predictor of higher analgesic adherence (odds ratio, 1.93; P < .05). Conclusions: Gender could precisely predict cancer patients’ medication adherence. Women experienced significantly greater pain than did men but also had more hesitancy to use analgesics, lower adherence, and inadequate pain management. Implications for Practice: Healthcare professionals should consider women as a high-risk group for inadequate pain control. It is crucial for health providers to consider the gender discrepancy when attempting to improve cancer pain management.

Validation of the Chinese-version self-efficacy in smoking cessation service scale (SE-SCS) for clinical psychiatric professionals

BACKGROUND Smoking cessation has been an important issue of concern for Taiwans psychiatric nurses since promulgation of the Tobacco Hazards Prevention Act. However, Taiwan has lacked a qualified tool to evaluate the self-efficacy of nurses in providing smoking cessation services. PURPOSE The purpose of this study was to validate the Chinese version of the Self- Efficacy in Smoking Cessation Service Scale (SE-SCS). METHODS A back translation approach was used to develop the SE-SCS Chinese version. We enrolled 193 psychiatric nurses from two psychiatric centers in central and southern Taiwan to assess the reliability and validity of the Chinese version scale using internal consistency, test-retest, factor analysis, and concurrent criteria validity. RESULTS The reliability of the SE-SCS Chinese version was assessed as good (Cronbachs α = .85) and the Pearson correlation for total test-retest score was acceptable (r = .65, p = .004). Explanatory factor analysis revealed that one factor explained 63.4% of total variance. As to the criteria validity, frequency of smoking cessation service provision was the main criterion, with a correlation of 0.25-0.26. We identified a low, but significant correlation (p < .001). CONCLUSION The SE-SCS Chinese version appears to be a valid measure for assessing psychiatric nurse self-efficacy in providing smoking cessation services.

Fear of Recurrence as a Predictor of Care Needs for Long-term Breast Cancer Survivors

Background: The improved survival rate for breast cancer has increased the number of women living with the diagnosis for more than 5 years. Limited studies have focused on the care needs for long-term healthy survivors of breast cancer. Objective: The aims of this study were to understand the care needs of long-term breast cancer survivors and identify related factors that influence these needs. Methods: A convenience sampling with a correlational study design was used. Women at least 20 years old, who were given a diagnosis of breast cancer at least 5 years, were recruited from 2 hospital clinics in southern Taiwan. A self-administered questionnaire measuring cancer survivors’ unmet needs was administered after obtaining informed consent. Binary logistic regression was used to examine variables associated with unmet care needs. Results: Of the 192 women participating, the highest unmet needs related to existential survivorship. The most frequently endorsed unmet need was for an ongoing case manager. Fear of recurrence was associated with 3 aspects including existential survivorship, comprehensive cancer, and quality-of-life unmet needs (odds ratio, 1.14–1.21). Conclusions: Even 5 years after the diagnosis and completion of therapy, women continue to report unmet needs. Evaluating women’s fear of recurrence to identify high-risk women with unmet needs is critical to providing quality care. Implication for Practice: Developing appropriate survivorship care programs combined with managing concerns regarding recurrence by a nursing case manager is needed.