ABSTRACT
AIM: This paper is a report of a review conducted to define the manifestations that characterize psychological distress during the diagnostic phase for suspected breast cancer, define the extent of psychological distress associated with the threat of potential cancer, and identify factors influencing psychological distress levels. BACKGROUND: Raising the possibility that a malignancy might be present is threatening. The resulting distress is believed to influence treatment outcomes in those diagnosed with cancer and result in behavioural changes in those with benign disease. DATA SOURCES: Research papers published between January 1983 and May 2009 were identified in CINAHL, MEDLINE and PsycINFO. The search was performed using the following terms: breast cancer diagnosis, mammography, breast biopsy, breast diagnostic, anxiety, distress and uncertainty. REVIEW METHODS: A systematic review was conducted of 30 studies meeting the inclusion criteria of a quantitative design with at least one standardized measure of distress and specifically addressing distress during the evaluation period. RESULTS: It is well-documented that distress, manifested as anxiety, exists. In a small cohort of women, distress levels are heightened to worrying levels that may have long-term implications. There was strong evidence for relationships among medical history, education and trait anxiety with distress. There was no substantiation of the association between younger age and increased psychological distress that has been consistently reported with other cancers. CONCLUSION: It is necessary to understand the impact of factors on distress so that heightened levels can be predicted and targeted by interventions initiated at the first mention of the possibility of the presence of malignancy.
Subject(s)
Anxiety/psychology , Attitude to Health , Breast Neoplasms/diagnosis , Breast Neoplasms/psychology , Stress, Psychological/psychology , Adaptation, Psychological , Biopsy/psychology , Female , Humans , Mammography/psychology , Personality , UncertaintyABSTRACT
PURPOSE/OBJECTIVES: To present the state of the science on uncertainty in relationship to the experiences of women undergoing diagnostic evaluation for suspected breast cancer. DATA SOURCES: Published articles from Medline, CINAHL, PubMED, and PsycINFO from 1983-2008 using the following key words: breast biopsy, mammography, uncertainty, reframing, inner strength, and disruption. DATA SYNTHESIS: Fifty research studies were examined with all reporting the presence of anxiety persisting throughout the diagnostic evaluation until certitude is achieved through the establishment of a definitive diagnosis. Indirect determinants of uncertainty for women undergoing breast diagnostic evaluation include measures of anxiety, depression, social support, emotional responses, defense mechanisms, and the psychological impact of events. CONCLUSIONS: Understanding and influencing the uncertainty experience have been suggested to be key in relieving psychosocial distress and positively influencing future screening behaviors. Several studies examine correlational relationships among anxiety, selection of coping methods, and demographic factors that influence uncertainty. A gap exists in the literature with regard to the relationship of inner strength and uncertainty. IMPLICATIONS FOR NURSING: Nurses can be invaluable in assisting women in coping with the uncertainty experience by providing positive communication and support. Nursing interventions should be designed and tested for their effects on uncertainty experienced by women undergoing a breast diagnostic evaluation.
Subject(s)
Attitude to Health , Breast Neoplasms , Uncertainty , Adaptation, Psychological , Anxiety/psychology , Breast Neoplasms/diagnosis , Breast Neoplasms/psychology , Communication , Cost of Illness , Defense Mechanisms , Depression/psychology , Female , Humans , Life Change Events , Nurse's Role , Nursing Methodology Research , Patient Education as Topic , Research Design , Social SupportSubject(s)
Attitude of Health Personnel , Choice Behavior , Clinical Competence , Education, Nursing, Baccalaureate/organization & administration , Students, Nursing/psychology , Humans , Interprofessional Relations , Needs Assessment , Organizational Objectives , Peer Group , Self-Assessment , Surveys and QuestionnairesABSTRACT
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