Healthcare providers' experiences in providing sexual health care to breast cancer survivors: A mixed-methods systematic review.

AIMS: To analyse healthcare providers' (HCPs) experiences in sexual health care through the mixed-methods systematic review (MMSR). BACKGROUND: Sexual health for breast cancer survivors (BCSs) is becoming increasingly important as survivors live longer. HCPs are critical in providing sexual health care. DESIGN: A mixed-methods systematic review. METHODS: Literature searches were conducted in databases MEDLINE, CINAHL, Psychology & Behavioral Sciences Collection, Web of Science, Cochrane Library, Scopus, ClinicalTrials.gov and reference lists were searched from inception to 30 December 2022. Two independent reviewers extracted and analysed the data using the JBI guidelines for MMSR. RESULTS: After screening for 2849 citations, 19 studies were eligible for MMSR, involving 2068 HCPs. Most HCPs believe that sexual health care is their responsibility. However, sexual health was not adequately addressed. A lack of knowledge was the most significant barrier to providing sexual health care. Moreover, HCPs would like to acquire more knowledge and felt that current sexual healthcare training was inadequate. CONCLUSIONS: Findings suggest that HCPs did not frequently address sexual health in BCSs and that lack of knowledge was the most common barrier. Healthcare session administrators should allocate resources for sexual healthcare training that offer multiple formats, accessible content and convenience. They should also be multifaceted and proactive, meet the diverse needs of BCS at different stages and focus on effective communication. RELEVANCE TO CLINICAL PRACTICE: This study highlights the importance of addressing sexual health in BCSs and the need for HCPs to receive training in this area. Training should be multifaceted, proactive and meet the diverse needs of BCSs at different stages, with a focus on effective communication. By addressing this issue, HCPs will be better equipped to support the sexual health needs of BCSs, ultimately improving their overall well-being and quality of life. PROSPERO Registration Number: CRD42022327018 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=327018).

Air pollution during the perinatal period and neurodevelopment in children: A national population study in Taiwan.

AIM: To evaluate the association between ambient particulate matter no larger than 2.5 µm in diameter (PM2.5 ) during the prenatal and postnatal periods and infant neurodevelopmental parameters. METHOD: We conducted a population-based birth cohort study using the Taiwan Birth Cohort Study. Participants were assessed for developmental conditions through home interviews at 6 months and 18 months of age. Exposure to PM2.5 of mothers and infants during perinatal periods was estimated using hybrid kriging/land-use regression. The exposure was linked to each participant by home address. Logistic regression was then conducted to determine the risk of neurodevelopmental delay in relation to PM2.5 . RESULTS: A total of 17 683 term singletons without congenital malformations were included in the final analysis. PM2.5 during the second trimester was associated with increased risks of delays in gross motor neurodevelopmental milestones (adjusted odds ratio [aOR] 1.09 per 10 µg/m3 increase in exposure to PM2.5 ). Delayed fine motor development was also found to be related to exposure to PM2.5 in the second and third trimesters (aOR 1.06), as was personal-social skill (aOR 1.11 for the second trimester and 1.06 for the third). These neurodevelopmental parameters were unrelated to postnatal PM2.5 exposure. INTERPRETATION: Exposure to ambient PM2.5 during pregnancy was significantly related to delay in gross motor, fine motor, and personal-social development in this population-based study. WHAT THIS PAPER ADDS: Prenatal exposure to higher PM2.5 was associated with increased risk of delayed early neurodevelopment. The critical period for delayed gross motor development was the second trimester. The critical period for fine motor and personal-social development was the second and third trimesters.

The synergistic interaction between urbanicity and maternal education affecting childcare pressure related to autism spectrum disorder in two national birth cohort studies.

To gain a holistic approach for parental help-seeking behavior and ASD diagnosis, this study aimed to use two national birth cohort study datasets to investigate the pathway relationship between personal and social/environmental factors, including maternal perceived childcare pressure, maternal level of education, urbanization at age 3, and the chance of receiving a autism spectrum disorder (ASD) diagnosis at when children are aged 5.5 years (2.5 years later). The 2003 Taiwan Birth Cohort Pilot Study (TBCS-p; N = 1618) and 2005 Taiwan Birth Cohort Study (TBCS; N = 19,183) datasets were used. The TBCS-p and TBCS both showed similar prevalence of ASD (0.3-0.4%). Children with ASD characteristics, as measured using the Modified Checklist of Autism in Toddlers, had 8.27-18.20 times increased likelihood of receiving ASD diagnosis [TBCS confidence interval (CF) of 5.32-12.86; TBCS-p CF of 2.03-163.46]. Pathway analysis showed that, although having a mother with higher education or who lived in a city decreased the chance for ASD diagnosis, the interactive effect of a maternal higher level of education and living in a city led to an increased likelihood for ASD diagnosis. Additionally, mothers who perceived a higher level of childcare pressure were also more likely to seek medical assistance and diagnosis. Access to healthcare (living in the city), maternal level of awareness (level of education), and perceived childcare pressure are all factors that influence help-seeking behavior and diagnosis. Therefore, medical professionals should pay special attention to the developmental condition of children in underserved backgrounds and rural areas to prevent delayed diagnosis.

Dissociative Trait as a Mediator of Problematic Internet Use in Children with attention-deficit/hyperactivity Disorder and Learning Disabilities.

PURPOSE: This study used data from a national birth cohort study to investigate the duration of internet use at the age of 12 years among children diagnosed with attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), intellectual disabilities (IDs) and learning disabilities (LDs) at the age of five and a half years (66 months) to understand whether an ADHD, ASD, ID and LD diagnosis in childhood increases the risk of problematic internet use (PIU) in adolescence. Furthermore, the pathway relationship of dissociative absorptive trait with PIU and these diagnoses was also investigated. METHODS: The 5.5- and 12-year-old Taiwan Birth Cohort Study dataset was used (N = 17,694). RESULTS: More boys were diagnosed with LDs, IDs, ADHD and ASD; however, girls were at increased likelihood of PIU. ID and ASD diagnoses were not associated with increasing PIU likelihood. However, children who had been diagnosed with LDs and ADHD, along with higher dissociative absorptive trait, had an indirectly increased likelihood of PIU in adolescence. CONCLUSIONS: Dissociative absorption was found to be a mediating factor between childhood diagnosis and PIU and can be used as a screening indicator in prevention programs to reduce the duration and severity of PIU in children diagnosed with ADHD and LDs. Furthermore, with the increased prevalence of smartphone usage in adolescents, education policy-makers should pay greater attention to the issue of PIU in female adolescents.

[A Brief Introduction to Mixed Methods Systematic Review (MMSR)].

Systematic reviews provide important empirical evidence for healthcare providers to make the best clinical decisions. While qualitative research provides subjective information on the human experience, quantitative research may be used to provide quantified evaluations of interventions. To overcome the lack of objectivity in qualitative research and of context considerations in quantitative research, recent efforts have focused on developing mixed-method approaches that combine meta-analysis (quantitative systematic reviews) and meta-synthesis (qualitative systematic reviews). This new idea may help conceptualize studied phenomena more thoroughly. However, the typology remains inconsistent and the currently proposed approaches lack unified guidance and principles. In this paper, "mixed methods systematic review", a term promoted by the Joanna Briggs Institute, is used to indicate the newly developed systematic review. The use of systematic review in quantitative research and in qualitative research and the use of mixed methods systematic review are introduced chronologically, with an emphasis on procedures, examples, and quality appraisal tools. The concepts and concrete procedures for integrating results from different research method are presented for researchers and healthcare providers to allow them to better understand this approach and explore related phenomena more thoroughly.

[Metamorphosis of Nurses: The Development and Breakthroughs of Advanced Practice Registered Nurses].

BACKGROUND: The introduction and development of the advanced practice registered nurse (APRN) is a global trend in nursing. However, the development of APRNs in Taiwan remains uncertain and lacks necessary consensus. PURPOSE: This research study aimed to explore the views and suggestions of nursing experts in industry, government, and academia regarding the development of APRNs (clinical nurse specialists, case managers, certified clinical registered nurse anesthetists, and certified nurse-midwives) in Taiwan. METHODS: Data were collected from March to August 2017. Sixty-four experts participated in one of six focus group discussions held in northern, central, and southern Taiwan. These group discussions were recorded and transcribed verbatim with the consent of the participants. Content analysis was used to analyze the transcribed data. RESULTS: The comments and suggestions raised during the discussions were categorized into four major themes: professional development of necessity, core competencies, accreditation, and future promotion-related issues. Each theme was further divided into several subthemes. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The opinions of relevant experts regarding the current status of development of the roles, practical scope, and management and suggestions for APRNs were summarized to facilitate the future development of APRNs in Taiwan in terms of education, core competencies, certification, and practical scope. Furthermore, the results may be referenced in the establishment of a nursing consensus model and as a basis for promoting APRNs.

Recalled Parental Gender Preference in Chinese Culture: A Taiwan Birth Cohort Study.

Chinese culture has long favored sons over daughters. With the development of reproductive technology, the methods can be used not only in facilitation of conception, but also in sex-selective termination of pregnancies. Therefore, this study aimed to investigate: (1) the rate of pregnant expectancy/planning of children; (2) whether the Chinese cultural influence of son preference still exists, and factors effecting sex preference; and (3) whether artificial reproductive technology plays a role in parents giving birth to a child of their preferred sex. We used the Taiwan Birth Cohort Study dataset at six-months, which included 21,248 babies born in 2005. More mothers than fathers reported this pregnancy as unexpected (29.0% vs. 20.5%). Over half of the parents showed no preference for the sex of their child (mothers: 52.6%, fathers: 55.8%). However, among those who showed a preference, significantly more preferred sons than daughters (son preference, mothers: 24.8%, fathers: 24.3%; daughter preference, mothers: 22.5%, fathers: 19.9%). Additionally, structural equation modeling found that parents who had planned their pregnancy were more likely to prefer sons and less likely to prefer daughters. Parents who used artificial reproductive technology for conception were more likely to prefer and conceive sons. A preference for male children still exists in Taiwan, contributing to the high sex ratio at birth of 110 in our 2005 birth cohort. However, over half of the parents reported being neutral in the preference of the gender of their offspring. This suggests that Taiwan is moving toward a more gender-equitable society.

[Cross-Disciplinary Research in Nursing: Competency and Practice].

Cross-disciplinarity is a current trend in healthcare. With the advancement of science and technology, the expansion of care fields, and the complexity of health problems, cross-disciplinary research has been increasingly emphasized in nursing studies in order to introduce technology into patient care, expand the scope of healthcare research, and improve quality of care. The term cross-disciplinary research typically covers multidisciplinary, interdisciplinary, and transdisciplinary studies. Each of these types of studies differ in terms of connotation, level of research problem addressed, and degree of interaction involved. The main purpose of this article is to describe the significance of cross-disciplinary research in nursing and to distinguish the types and nature of cross-disciplinary studies. Furthermore, reflections and recommendations on cross-disciplinary nursing research are also proposed. The development of cross-disciplinary nursing research is phased in nature and requires the creation of a cross-disciplinary research center and excellent leadership. Conducting cross-disciplinary nursing research is challenging and affected by uncertainty. Researchers may select the type of cross-disciplinary research that best addresses the complexity and commonality of the research problem being addressed. In addition, researchers may expand, communicate, and interact with other disciplines to improve their interdisciplinary research capabilities and opportunities.

The Psychometric Properties of the Chinese Oxford Happiness Questionnaire in Taiwanese Adolescents: Taiwan Birth Cohort Study.

The application of the eight-item Oxford Happiness Questionnaire has rarely been investigated cross-culturally. This study examined the psychometric properties and use of the eight-item Oxford Happiness Questionnaire in Taiwan, using a national birth cohort dataset of 12 year olds as a sample. The dataset of 12-year-old children in the Taiwan Birth Cohort Pilot Study, which included 17,694 adolescents, was used for this study. The eight-item Oxford Happiness Questionnaire was double-translated into Mandarin Chinese. Item analysis, exploratory factor analysis, and structural equation modeling for construct validity were conducted. The four-point Likert scale for the eight-item Chinese Oxford Happiness Questionnaire showed good inter-item correlation. Having deleted the item "mentally alert", the remaining seven items were separated into two dimensions of social adaptation status (SAS) and psychological well-being (PWB), resulting in Cronbach's alpha scores of 0.63 and 0.55, respectively. The two dimensions showed good construct validity. The differences in the language and cultural connotations of being "mentally alert" are discussed. Furthermore, being of a collective culture, the two dimensions of SAS and PWB were found in Chinese adolescents, allowing distinction between social- and individual-oriented happiness. Our study showed that the seven-item Oxford Happiness Questionnaire has a scale that is easy to use and comprehend, with good psychometric properties for use with Chinese adolescents.

Measurement of Social Communication, Emotion and Cognitive Development from 6 Months to 8 Years Old: In a Taiwan Birth Cohort Study.

This study aimed to investigate (1) the reliability and validity of the Taiwan Birth Cohort Study-Developmental Instrument (TBCS-DI) 8-year-old scale; (2) the pathway relationship among the cognitive, emotional and social-communication dimensions of the TBCS-DI 8-year-old scale; (3) the predictive validity and association of the TBCS-DI dimensions at 6, 18, 36, and 66 months, with the dimensions of the 8-year-old scale. The Taiwan Birth Cohort Study dataset of 19,516 children followed from 6 months to the age of eight was used. The TBCS-DI 8-year-old scale showed good reliability and validity. A recursive relationship of emotion as the basis, affecting cognition and later social communication was found. Children's 18-month development was able to predict the development of children at 8 years, implying that 18 months may be a critical age for screening and intervention. Clinical intervention should also take into consideration the cultural disparity of emotional development in Asian countries.

A qualitative exploration of the fear of recurrence among Taiwanese breast cancer survivors.

OBJECTIVE: Fear of cancer recurrence (FCR) is the most commonly reported problem and unmet need among breast cancer survivors. The aim of this qualitative study was to explore the experience of recurrence fears among Taiwanese breast cancer survivors. METHODS: Three focus groups were included in this study. A purposive sampling technique was used to recruit 11 recurrence-free women at least 20 years of age from southern Taiwan who were diagnosed with breast cancer within the previous 2 years. Data were analysed and interpreted using content analysis. RESULTS: Three themes reflecting the experience of FCR were extracted from the transcript analyses: "Trapped in insecurity," "Suffering in silence," and "Pretending as if nothing happened." Participants endured a complex set of circumstances akin to silently walking the survival tightrope. Breast cancer survivors were still insecure and suffering, rather than celebrating survival, after the completion of treatment. Fear of cancer recurrence silently dominated their lives. CONCLUSIONS: An avoidance mindset and an unspoken FCR leave survivors insecure, resulting in a silent survival journey. These difficult thoughts and feelings that may impact the reconstruction of post-cancer life should be acknowledged. The development of appropriate survivorship care programs and emotional resilience regarding recurrence is needed for Taiwanese breast cancer survivors.

Advanced Maternal Age and Maternal Education Disparity in Children with Autism Spectrum Disorder.

Objective Previous studies have shown inconsistent results with regard to the association between advanced parental age and autism spectrum disorder (ASD). The sociodemographic status of parents has been found to be associated with children with ASD, however. Therefore, a pathway analysis was undertaken of the roles of maternal age and education in ASD diagnosis and community screening, in a national birth cohort database, using a propensity score matching (PSM) method. Method The 6- and 66-month Taiwan Birth Cohort Study dataset was used (N = 20,095). The PSM exact matching method was used to select 1700 families (ratio of 1:4 between ASD diagnosis and control) from the Taiwan Birth Cohort Study dataset. Results (1) The results from the complete dataset and the PSM exact matching dataset both show that the risk of a child being diagnosed with ASD was increased by the mother being over 40 years old. (2) Although more children of mothers with lower-than-average education were positive on screening, more children of mothers with higher-than-average education were also diagnosed with ASD. Conclusions for Practice Advanced maternal age had a higher association with the diagnosis of ASD, and maternal educational disparity was found between ASD clinical diagnosis and community screening. Community and primary medical care services should pay more attention to children of parents with lower education during ASD screening to prevent delayed diagnosis.

[The Application of Mindfulness in Promoting Happiness and Mental Health].

Happiness, an important factor in maintaining health, not only enhances the abilities of self-control, self-regulation, and coping but also promotes mental health. Mindfulness therapy has been increasingly used in recent years. Therefore, the purpose of the present article is to introduce the concepts of mindfulness and to describe the relationship between mindfulness and happiness. Further, we provide brief introductions to mindfulness-based stress reduction and mindfulness cognitive therapy as well as present the current evidence related to the effects of mindfulness programs and therapies in clinical patient care. The information in the present article may be referenced and used by nurses in patient care and may be referenced by health professionals to promote their own mental health in order to maintain optimal fitness for providing high-quality patient care.

[Self-Awareness of Disease Stigma: Reflections of Healthcare Professionals].

People who suffer from disease frequently experience disease-related stigmas. Stigma presents in daily life during normal human interactions. The stereotypes promoted by the media often impact public opinion significantly. Moreover, healthcare professionals may exacerbate stigmatization due to their misunderstanding of patients and their disease issues. Therefore, the reflection on stigma of healthcare professionals cannot be ignored. The present article illustrates the issue of stigmas held by healthcare professionals, their related stigmas, and their self-awareness. It is hoped that all healthcare professionals may cooperate to develop an anti-stigma strategy and to become true spokespersons for their patients.

Effects of a strengths-based perspective support group among Taiwanese women who left a violent intimate partner relationship.

AIMS AND OBJECTIVES: To examine the effects of an 8-week strengths-based perspective group intervention on hope, resilience and depression in Taiwanese women who left a violent intimate partner relationship. BACKGROUND: Studies on interventions for abused women have primarily focused on psychological problems. However, the effect of group intervention on the psychological strengths of abused women is still unknown. DESIGN: A two-group, quasi-experimental design using repeated measures was used in this study. METHODS: Twenty-nine Taiwanese women who left violent intimate partner relationships were assigned to two groups and five participants did not complete the study. The experimental group (n = 8) underwent an 8-week strengths-based perspective group intervention developed by the investigators; the control group (n = 16) received no intervention. The effects of the intervention on the participants' hope, resilience and depression levels were evaluated as a pretest, post-test 1 (8th week) and post-test 2 (12th week) and were compared. The Chinese version of the State Hope Scale, the 25-item Resilience Scale, and the Taiwanese Depression Questionnaire were used in this study. RESULTS: On the eighth and twelfth weeks after the strengths-based perspective group intervention, we found significantly lower scores on the depression scale in the experimental group. In the eighth week, participants in the experimental group had significantly lower scores on the pathway of hope subscales than those in the control group. CONCLUSIONS: A strengths-based perspective support group intervention designed specifically for women who left a violent intimate partner relationship significantly reduced the participants' level of depressive symptoms and improved the pathway component of hope. RELEVANCE TO CLINICAL PRACTICE: This research highlights the importance of nurses not only focused on problems but also on the psychological strengths in practice of abused women survivors.

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

PURPOSE: The aims of the study were the following: (1) to understand the relationship between women's perceptions of empathy from their partners and their depressive symptoms and body image and (2) to examine the moderating effects of women's perceptions of empathy from their partners on the relationship between body image and depressive symptoms. METHODS: A cross-sectional and correlational design was used, in which a convenience sample of 151 women who completed surgery and the necessary chemotherapy/radiotherapy were recruited from southern Taiwan. A structured questionnaire including the Other Dyadic Perspective-Taking Scale, the Body Image Scale, and the Center for Epidemiologic Studies Depression scale were administered. Hierarchical regression was used to examine the moderating effects of empathy from partners between the women's body image and their level of depressive symptoms. RESULTS: The results showed significant relationships between empathy from a partner and depressive symptoms (p < 0.001). However, there was no significant relationship between empathy from a partner and body image (p > 0.05). The moderating effect of empathy from a partner on the relationship between body image and depressive symptoms was also significant (p < 0.01). CONCLUSION: The more empathy women perceived from partners, the fewer depressive symptoms women reported. Empathy from a partner could moderate the impact of body image changes on depressive symptoms. Women's depressive symptoms, resulting from a change in body image after breast cancer surgery, might be minimized if they perceived greater empathy from their partners.

Mediating effects of social support on depression and quality of life among patients with HIV infection in Taiwan.

Few empirical studies have evaluated the mediating effects of quality of life (QoL) among people living with HIV/AIDS (PLWHA). The purposes of this study were to identify the predictors of QoL and to test the mediating effects of social support on depression and QoL among patients enrolled in an HIV case-management program in Taiwan. A cross-sectional, descriptive correlation design collected data from 108 HIV-infected individuals. Individuals were assessed using the Beck Depression Inventory II, the short version of the World Health Organization Quality of Life Assessment (WHOQOL-BREF), and the Multidimensional Scale of Perceived Social Support between September 2007 and April 2010. After adjusting for sociodemographic characteristics (including age, gender, and mode of transmission) and clinical information (including CD4 count and time since diagnosis with HIV), the study findings showed that QoL was significantly and positively correlated with both social support and the initiation of highly active antiretroviral therapy (HAART), and was negatively correlated with depression and time since diagnosis with HIV. The strongest predictors for QoL were depression followed by the initiation of HAART and social support, with an R(2) of 0.40. Social support partially mediated the relationship between depression and QoL. Health professionals should enhance HIV-infected individuals' social support to alleviate the level of depression and further increase the QoL among PLWHA.

Towards the development of a gender-sensitive measure of women's mental health.

AIMS AND OBJECTIVES: To develop a gender-sensitive measure of women's mental health and to evaluate the measure's psychometric properties. BACKGROUND: Mental health problems are a leading global burden of disease, and gender differences in the prevalence of these problems are well documented. Improving mental health is as important as resolving mental health problems. Although many mental health scales have been developed, few measure women's positive mental health from a gender perspective. DESIGN: Instrument development and psychometric evaluation were used. METHODS: First, a new mental health scale (Women's Mental Health Scale) grounded in women's subjective experiences was formulated from the narratives of four female focus groups (n = 23). The new scale was evaluated using principal component analysis and internal consistency reliability in a sample of female participants (n = 106). Next, the Women's Mental Health Scale, the Chinese version of Beck Depression Inventory-II and Social Adjustment Scale Self-Report were used in a survey of female undergraduate students (n = 163) for examining the concurrent criterion-related validity. Finally, gender differences were examined by assessing the discriminated validity of the Women's Mental Health Scale in a sample of male and female undergraduate students (n = 357). All participants were recruited from communities and universities in middle and south Taiwan. RESULTS: A 50-item Women's Mental Health Scale with four concepts of self, interpersonal, family and social domains was developed. It revealed that the Women's Mental Health Scale had acceptable psychometric properties. There was a significant negative correlation between scores of the Women's Mental Health Scale and the Chinese version of Beck Depression Inventory-II and a significant positive correlation between scores of the Women's Mental Health Scale and Social Adjustment Scale Self-Report. There were significant gender differences in the family domain and social domain. Women reported greater mental health in the family domain and social domain than men. CONCLUSIONS: The Women's Mental Health Scale is a promising gender-sensitive tool to measure women's mental health. RELEVANCE TO CLINICAL PRACTICE: The Women's Mental Health Scale appears to be a gender-sensitive measure to assess the positive mental health potentials among women population.

[New perspective on psychiatric mental health nursing research: revisiting the resilience of children].

Rapid changes in societal and environmental conditions mean that many health issues remain unresolved, especially in the realms of childhood social-emotional and mental problems. These problems threaten to affect the future development of affected children. Therefore, this article introduces the new perspective on gene-environment interactions and epigenetics in neuroscience, the definition of resilience, and current developments in related research. This article further integrates the literature to identify the association of resilience in children's emotional and behavioral adjustment. These evidence-based studies demonstrate the significance of resilience intervention and assessment in psychiatric nursing. These developments hold the potential to upgrade clinical applications and enhance the development of individuals.

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.