Torill Christine Lindstrøm

Coping with breast cancer: between diagnosis and surgery

AIM This paper is a report of a descriptive study of coping strategies used by women between diagnosis of breast cancer and surgery. BACKGROUND Although research has suggested that the initial phase of breast cancer is important in the overall process of coping, there have been few qualitative studies conducted in the period between diagnosis and surgery to describe womens experiences and coping efforts in the midst of stress. METHOD Individual interviews were conducted with 21 women with newly diagnosed breast cancer who were awaiting surgery. Data were collected from February 2006 to February 2007 at a Norwegian university hospital. Transcripts were analysed using methods of qualitative content analysis. FINDINGS Prominent themes about coping between diagnosis and surgery were: step-by-step, pushing away, business as usual, enjoying life, dealing with emotions, preparing for the worst and positive focus. The women were highly aware of the threat of death, but at the same time hopeful and optimistic. In general, they wanted to be treated as usual. Pity and compassion could increase their feelings of fear and vulnerability. Emotions were dealt with either by openness or by holding back. CONCLUSION Avoiding being overwhelmed by emotional reactions was a major goal for the women. Their coping strategies displayed similar patterns but diverged on some points. In general they needed to manage the situation in their own way. By being aware of womens individual needs and different coping strategies, nurses and other healthcare professionals can improve support to women in this vulnerable situation.

Being in suspense: women’s experiences awaiting breast cancer surgery

AIM This article is a report of a qualitative study of womens experiences after having received a breast cancer diagnosis and awaiting primary surgery. BACKGROUND Breast cancer is experienced as an important stressor and a major challenge. How women appraise the diagnosis affects their postsurgery adaptation. Although studies have documented the presurgery period as stressful, in-depth understanding of womens experiences while awaiting surgery studied during this stressful period is still needed. METHOD Twenty-one women with newly diagnosed breast cancer were interviewed individually the day before surgery at a Norwegian university hospital, between February 2006 and February 2007. Interviews were analysed using the qualitative meaning condensation method. FINDINGS Feeling healthy, but having to adapt to disease, waiting, uncertainty, having to tell and existential awareness were themes identified. Having to wait was experienced as frightening, painful, long and difficult - but also necessary. Some expressed apprehension because they could not do anything about their situation. Others emphasized that it was good to have some time between diagnosis and surgery to become personally prepared and spend time with loved ones. Informing others about the diagnosis was a great burden for most of them. Social networks could both give and crave support. CONCLUSION Healthcare professionals need to be sensitive to the individual experiences of women awaiting breast cancer surgery to give support to ease their situation. Setting the date for surgery will alleviate anxiety. Follow-up studies about the potential impact of presurgery experiences on later experiences of living with breast cancer and intervention studies are needed.

Does sense of coherence affect the relationship between self-rated health and health status in a sample of community-dwelling frail elderly people?

Background: The objective of this study was to examine the association between self-rated health (SRH) and physical, functional, social and mental health measures in community dwelling elderly people needing nursing care. Of special interest was how coping resources (SOC) influenced this relationship. Self-rated health is a good predictor of future health status as measured by mortality and morbidity, decline of functional abilities, use of healthcare, and nursing home placement. The high mean age and the relatively high level of care-dependency in this sample, make this investigation important. Methods: A hierarchical regression analysis was applied in a cross sectional sample of 242 elderly (mean age 84.6 years). Results: Subjective health complaints (SHC) in both sexes, and psychological distress (only in men), was associated directly with SRH. Coping resources associated with SRH directly, and indirectly through subjective perceived health (SHC and GHQ) but only in men. The influence of registered illness was mediated through the effects of subjectively perceived health in both women and men. Sex differences moderated the effects of SOC on SRH. Conclusion: Subjectively perceived health was more important in the perception of SRH than objective health measures. Men, in contrast to women, tend to convert physical illness into emotional distress.

Experiencing the presence of the dead: Discrepancies in "the sensing experience" and their psychological concomitants.

Relationships between experiencing “the presence of the dead” and psychological outcome parameters were studied in thirty-nine widows, early in bereavement and twelve months later. Self-evaluation of coping, expectancies about future coping, and scores on psychological standard questionnaires (“Spielberger State-Trait Anxiety Scale” (STAI), “Goldberg Health Questionnaire” (GHQ), “General Well-Being Schedule” (GWB), “Sjõberg Measurement of Mood” (SJO) and “Life Style Index” (LSI) were used as indicators of outcome. A majority of the widows reported “sensing experiences” at both occasions. The sensing experiences were categorized as being “neutral to slightly positive,” “extremely positive,” and “extremely negative.” “Extremely positive,” and “extremely negative” experiences were found to be associated with poor adaptational outcomes, whereas “neutral to slightly positive experiences” and no sensing experiences were associated with good outcomes. The nature of the sensing experience, therefore, seems to predict adaptation after bereavement.

The support I need: women's experiences of social support after having received breast cancer diagnosis and awaiting surgery.

Background: Social support is associated with a better adjustment to breast cancer, whereas inadequate social support increases psychological distress. However, the period between diagnosis and surgery is particularly stressful, and few studies have addressed the significance of social support in this period. Objective: The purpose of this study was to describe women’s individual experiences of social support after having received a breast cancer diagnosis and awaiting surgery. Methods: A qualitative descriptive design was used. Individual semistructured interviews were conducted the day before surgery with 21 women aged 41 to 73 years with newly diagnosed breast cancer at a Norwegian university hospital. Results: Methods of qualitative meaning condensation analysis revealed 5 themes: available support, information and advice, care, having confidants, and balancing distance and closeness. Knowing that both family and healthcare professionals were available and caring gave a sense of security. Social support gave strength, although too much could be experienced as difficult and frightening. The women needed a balance between distance from and closeness to their social network. Both professional information and someone professional with whom to talk personally were essential. Conclusions: Social support is an important resource for women with breast cancer but can be a double-edged sword as the network’s offered support can sometimes be a burden. Implications for Practice: Healthcare professionals could call each patient, encourage the patients to call if they want, and, if preferred, offer face-to-face consultations for women with breast cancer awaiting surgery. This contact should be a supportive, informative, and confidential available resource.

Psychological distress and its correlates in older care-dependent persons living at home

Objectives: This study examined psychological distress in older people receiving home nursing care. The influence of risk factors and personal resources on their perceived psychological distress was also examined. Method: A linear regression analysis was applied in a cross-sectional sample of 214 patients aged 75 years and older. Psychological distress was measured using the General Health Questionnaire (GHQ). The independent variables were sex, education, age, living arrangement, household composition, reported illnesses, Barthel ADL Index, self-rated health, Subjective Health Complaints, Clinical Dementia Rating Scale, Sense of Coherence and Revised Social Provision Scale. Results: Of the 214 participants, 23 (10.7%) reported experiencing psychological distress using a cutoff point of 4 or more on a GHQ case score. Sense of coherence, education and subjective health complaints were the only factors that were significantly related to psychological distress in the multivariate analysis. Conclusion: The general level of psychological distress was low. Low psychological distress was related to an inner strength conceptualized as sense of coherence. Commonly reported risk factors such as sex, household composition and perceived social support, and objective measures of somatic and mental health and bodily dysfunctions were not related to psychological distress. Suggested reasons for this are greater acceptance of bodily and functional shortcomings and of changes related to goal achievement in old age, according to the model of selective optimization with compensation.

Anxiety and adaptation in bereavement

Abstract Six to eight weeks after the loss of their husbands, thirty-nine Norwegian widows were studied with standard questionnaires: Spieiberger State-Trait Anxiety Scale (STAI), Goldberg General Health Questionnaire (GHQ) and The General Well-Being Schedule (GWB). Significant changes in adaptation took place within the first year of bereavement. There was a connection between the severity of the early emotional reactions and the resultant level of adaptation. The initial reactions predicted the level of adaptation one year after the loss. One year of bereavement seemed to be a period within which readaptation took place after the loss of the spouse. Changes in anxiety as a personality trait was found, indicative of the potential long-term effects of psychological trauma.

Agency ‘in itself’. A discussion of inanimate, animal and human agency

‘Agency’, the concept, its connections to ontology and its uses within archaeological theory, are discussed and criticized. In recent archaeological theory, the term ‘agency’ has been attributed to things, plants, animals and humans. In this paper it is argued that the term ‘agency’ is logically meaningless if applied to everything that moves or has effects on its surroundings, and that we need a new, more precise terminology that discriminates between ‘agency’, ‘effect’, ‘actant’ and ‘effectant’. That people, of all cultures, perceive and experience things/objects as having agency is explained as being due to projections of human characteristics, human psycho-neurological functioning, and the fact that all individuals and cultures are deeply involved with and dependent on things/objects. Connected to this, questions regarding different ontologies, animism, ethics and sciences are discussed. The paper presents a critique of symmetrical archaeology and materiality studies. Broader paradigmatic perspectives, more theoretical and methodological inclusiveness, and more inter- and trans-disciplinary endeavours are suggested to increase archaeologys ‘agency’.

'I am the Walrus': Animal Identities and Merging with Animals - Exceptional Experiences?

Archaeological materials from various times and places give us many examples of identity attributed to animals and of merging of identities between humans and animals. We tend to regard these phenomena as different from our modern understanding of ourselves, animals, plants and objects as discrete ontological classes. Accordingly, archaeology explains and explores these phenomena in relation to what they implied and meant in their particular cultural contexts. However, these phenomena also share certain cross-cultural and trans-temporal similarities, pointing beyond cultural ‘uses’ (processual) and ‘meanings’ (post-processual) of animals. This observation demands the employment of a wider, more inclusive, theoretical stance (multi-theoretical, multi-methodological, eclectic) to be explained. I illustrate with examples from various periods (Palaeolithic, Bronze Age, Iron Age, pre-classical and classical Greece, Roman Empire, Migration Period and Viking Period). I claim that characteristics of both human and animal nature (‘things in themselves’) can contribute to explaining the experiences of animal identities and of merging phenomena. Both phenomena connect to perceptions of, interaction with and relationships with animals. My arguments are based on research on human and animal psycho-endocrinology, brain and behaviours (cognitive, emotional and social) and ethology.

The Subjective Health Complaints Inventory: a useful instrument to identify various aspects of health and ability to cope in older people?

Aims: The aims were to investigate the factor structure of the Subjective Health Complaints Inventory (SHC) in a population of 75 years and above and to identify whether somatic, psychosocial, and coping factors were associated with the SHC factors. Methods: Data from 242 elderly persons were analyzed. The measures were: the SHC Inventory, Sense of Coherence, Social Provision Scale, Self-Rated Health, General Health Questionnaire, Clinical Dementia Rating, Reported Illness, Barthel ADL Index, sex, age, and education. Results: The factor analysis resulted in four subgroups: musculoskeletal pain (15% of variance), gastrointestinal problems (12% of variance), respiratory/allergy complaints (11% of variance), and pseudoneurology (11% of variance). The occurrence of complaints was 76% for musculoskeletal complaints, 51% for gastrointestinal complaints, 30% for flu, 43% for allergy, and 93% for pseudoneurology. Self-rated health and reported illness were significantly associated with musculoskeletal complaints (15% of variance), impairment in activities of daily living (ADL) with gastrointestinal complaints (3% of variance), and finally sense of coherence, self-rated health, and psychological distress were associated with pseudoneurology (32% of variance). No variables were associated with respiratory/allergy complaints. Conclusions: This study supports the stability of the SHC’s factor structure. The low occurrence of health complaints could possibly be due to survival effects, or that old people to a greater extent than younger people compare themselves with aged peers. The subscales focusing on somatic symptoms were explained by reported illnesses and functional impairments to a limited degree only. The pseudoneurology subscale score was associated with psychological measures, particularly ability to cope.