Colorectal cancer survivors' adjustment to permanent colostomy in Switzerland: A qualitative analysis.

Colostomized colorectal cancer survivors present physical, psychological, and social difficulties after treatment, which complicate their return to normal life. Nevertheless, we lack insight into their lived transition experience after treatment in Switzerland. We led nine semi-structured interviews with participants who had a colostomy for a mean of 16.4 years. The participants' mean age was 73.1 years. Through an inductive thematic analysis, we highlighted several adaptation difficulties. Their body image was poor, and they behaved differently than before the surgery. For fear of being rejected, they concealed their colostomy. However, they felt isolated and often wished for more support. They may be in a vicious circle where their difficulties are maintained. We advocate that supporting survivors psychologically beyond the end of their treatment is essential to facilitate adjustment and overcome cancer.

Multimorbidity and clinical reasoning through the eyes of GPs: a qualitative study.

OBJECTIVES: Despite the high prevalence of patients suffering from multimorbidity, the clinical reasoning processes involved during the longitudinal management are still sparse.This study aimed to investigate what are the different characteristics of the clinical reasoning process clinicians use with patients suffering from multimorbidity, and to what extent this clinical reasoning differs from diagnostic reasoning. DESIGN: Given the exploratory nature of this study and the difficulty general practitioners (GPs) have in expressing their reasoning, a qualitative methodology was therefore, chosen. The Clinical reasoning Model described by Charlin et al was used as a framework to describe the multifaceted processes of the clinical reasoning. SETTING: Semistructured interviews were conducted with nine GPs working in an ambulatory setting in June to September 2018, in Geneva, Switzerland. PARTICIPANTS: Participants were GPs who came from public hospital or private practice. The interviews were transcribed verbatim and a thematic analysis was conducted. RESULTS: The results highlighted how some cognitive processes seem to be more specific to the management reasoning.Thus, the main goal is not to reach a diagnosis, but rather to consider several possibilities in order to maintain a balance between the evidence-based care options, patient's priorities and maintaining quality of life. The initial representation of the current problem seems to be more related to the importance of establishing links between the different pre-existing diseases, identifying opportunities for actions and trying to integrate the new elements from the patient's context, rather than identifying the signs and symptoms that can lead to generating new clinical hypotheses. The multiplicity of options to resolve problems is often perceived as difficult by GPs. Furthermore, longitudinal management does not allow them to achieve a final resolution of problems and that requires continuous review and an ongoing prioritisation process. CONCLUSION: This study contributes to a better understanding of the clinical reasoning processes of GPs in the longitudinal management of patients suffering from multimorbidity. Through a practical and accessible model, this qualitative study offers new perspectives for identifying the components of management reasoning. These results open the path to new research projects.

Understanding GPs' clinical reasoning processes involved in managing patients suffering from multimorbidity: A systematic review of qualitative and quantitative research.

BACKGROUND: Most consultations in primary care involve patients suffering from multimorbidity. Nevertheless, few studies exist on the clinical reasoning processes of general practitioners (GPs) during the follow-up of these patients. The aim of this systematic review is to summarise published evidence on how GPs reason and make decisions when managing patients with multimorbidity in the long term. METHODS: A search of the relevant literature from Medline, Embase, PsycINFO, and ERIC databases was conducted in June 2019. The search terms were selected from five domains: primary care, clinical reasoning, chronic disease, multimorbidity, and issues of multimorbidity. Qualitative, quantitative, and mixed-methods studies published in English and French were included. Quality assessment was performed using the Mixed Methods Appraisal Tool. RESULTS: A total of 2 165 abstracts and 362 full-text articles were assessed. Thirty-two studies met the inclusion criteria. Results showcased that GPs' clinical reasoning during the long-term management of multimorbidity is about setting intermediate goals of care in an ongoing process that adapts to the patients' constant evolution and contributes to preserve their quality of life. In the absence of guidelines adapted to multimorbidity, there is no single correct plan, but competing priorities and unavoidable uncertainties. Thus, GPs have to consider and weigh multiple factors simultaneously. In the context of multimorbidity, GPs describe their reasoning as essentially intuitive and seem to perceive it as less accurate. These clinical reasoning processes are nevertheless more analytical as they might think and rooted in deep knowledge of the individual patient. CONCLUSIONS: Although the challenges GPs are facing in the long-term follow-up of patients suffering from multimorbidity are increasingly known, the literature currently offers limited information about GPs' clinical reasoning processes at play. GPs tend to underestimate the complexity and richness of their clinical reasoning, which may negatively impact their practice and their teaching.

Body image, sexual activity, and side effects of treatments across the first year after surgery in women facing breast cancer: The influence of attachment insecurity.

Objectives: The aim of this study was to assess, across the first year after surgery, the influence of attachment insecurity, that is, avoidant and anxious tendencies, on body image, sexual activity, and side effects of treatments in women diagnosed with breast cancer.Design: A total of 110 women with non-metastatic breast cancer were surveyed 2 weeks (T1), 3 months (T2), and 12 months (T3) after surgery.Methods: Self-reported questionnaires were used to assess attachment tendencies (avoidance and anxiety), medical data (cancer stage, oncological treatment), sociodemographic data (age, socioeconomic level, relational status), and the three outcomes.Results: Generalized linear modeling showed that (1) having more avoidant and anxious attachment tendencies predicted a more negative body image, as did being younger and having undergone a mastectomy; (2) having more avoidant attachment tendencies predicted being sexually inactive, as did having undergone neoadjuvant chemotherapy or adjuvant hormonal therapy, whereas being younger and in a committed relationship predicted being sexually active; and (3) attachment tendencies did not predict the intensity of side effects, whereas a higher cancer stage and being at the beginning of treatment predicted more side effects.Conclusions: Women with avoidant and anxious attachment tendencies may be especially vulnerable to the consequences of oncological treatment, in particular regarding body image and sexual activity.

Expressed emotion in couples facing breast cancer in women is associated with psychological distress in the first year after surgery.

The aim of this study was to assess the links between partners' and women's expressed emotion with the distress of one another during the first year after surgery for breast cancer in women. The design was longitudinal. A sample of 61 couples participated in the study at 2 weeks, 3 months, and 12 months after the surgery. Expressed emotion was assessed with the Five-Minute Speech Sample. Psychological distress was assessed with a self-reported questionnaire. Mixed-model analyses showed that partners' expressed emotion is associated with heightened psychological distress in women during the first year after surgery, even after medical data were controlled for.

We are in this together - Aren't we? Congruence of common dyadic coping and psychological distress of couples facing breast cancer.

OBJECTIVES: Breast cancer (BC) can be understood as a we-disease, which affects a couple as a unit and requires coping as a unit (eg, common dyadic coping, CDC). However, partners can be incongruent in their perceptions of CDC, for example, because of misunderstandings and lack of mutuality or conflict, which may likely be associated with greater distress. Thus, this paper examines the effect of CDC congruence on individual psychological distress in cancer patients and their partners. METHODS: Seventy mixed-sex couples in which the woman had nonmetastatic BC completed self-report questionnaires at 2 weeks, 3 months, and 1 year after cancer surgery. CDC congruence measured the difference between patients' and partners' CDC perceptions while controlling for CDC itself. RESULTS: Multilevel modeling showed negative associations between couples' CDC and psychological distress. Beyond this effect, female patients' psychological distress was associated with CDC congruence with an interaction showing that psychological distress was greater when couples were congruent with low rather than a high CDC. CONCLUSION: Less congruence was associated with greater psychological distress in BC patients but not their male partners - especially if the couple reported low CDC. Health professionals should identify and address diverging perceptions, so that additional distress can be minimized for BC patients.

[Sexuality after breast cancer is not a taboo]. / Sexualité après un cancer du sein: un sujet non tabou.

Local and systemic treatments have significantly improved the prognosis of patients with breast cancer. The diagnosis of the disease and its sometimes long-lasting treatments can, however, impair the sexual life of patients. This contributes to a deterioration of their quality of life and can also lead to an alteration of their therapeutic adhesion and therefore of their prognosis. For a long time, the subject remained taboo and little discussed between professionals and patients. It is now becoming obvious that, as with other aspects of medical care, the issue of sexuality must be raised by professionals in order to inform patients of the impact of treatments, to identify their needs, to prevent/treat any complications, and if necessary to refer them to specialists, psychologists/psychiatrists or sexologists.

Les traitements locaux et systémiques du cancer du sein ont permis une amélioration considérable du pronostic des patientes. Le diagnostic de la maladie et ses traitements, parfois de longue durée, peuvent toutefois bouleverser la vie sexuelle des patientes. Ceci contribue à une dégradation de leur qualité de vie et peut aussi mener à une altération de leur adhérence thérapeutique et donc de leur pronostic. Longtemps le sujet est resté tabou et peu abordé entre les professionnels et les patientes. Il devient actuellement évident que, comme pour les autres aspects de la prise en charge médicale, la question de la sexualité doit être abordée par les professionnels afin d'informer les patientes de l'impact des traitements, de dépister leurs besoins, de prévenir/traiter d'éventuelles complications et de les adresser à des spécialistes, psychologues/psychiatres ou sexologues, si nécessaire.

The protective effect of a satisfying romantic relationship on women's body image after breast cancer: a longitudinal study.

OBJECTIVE: To examine the protective role of relationship satisfaction on body image in women with breast cancer throughout the first year post-surgery. METHODS: Seventy-four Swiss patients engaged in a relationship filled out a questionnaire assessing body image disturbance 2 weeks, 3 months, and 1 year after surgery. A univariate latent change score model was used to analyze the evolution of body image disturbance and the contribution of relationship satisfaction to body image disturbance. RESULTS: Women who were satisfied with their relationship reported less body image disturbance than did dissatisfied women at 2 weeks post-surgery. Being married was also associated with less body image disturbance at that time. The protective effect of these relational variables was still observable 1 year later. Changes in body image disturbance over time were explained by the negative impacts of mastectomy and chemotherapy. CONCLUSIONS: How women perceive the impact of breast cancer treatment on their body may be partly determined by the quality of the relational context in which they live.

The caregiver burden in male romantic partners of women with non-metastatic breast cancer: The protective role of couple satisfaction.

We examined the evolution of the subjective burden of romantic partners caring for women with non-metastatic breast cancer and investigated the moderating role of couple satisfaction on caring stress. Forty-seven partners filled out questionnaires 3 and 12 months after surgery. Using a stress process model, we examined caring stressors and moderating factors (couple satisfaction, coping and social support) as predictors of subjective burden. Results showed that subjective burden decreases over time and that the couple satisfaction largely explains it above and beyond other influential variables. Partners dissatisfied with their couple relationship are especially vulnerable to the stress of caregiving.

Attachment and couple satisfaction as predictors of expressed emotion in women facing breast cancer and their partners in the immediate post-surgery period.

OBJECTIVES: To investigate expressed emotion (EE) in couples facing breast cancer in the immediate post-surgery period. EE may be predictive of psychological disturbances that hinder both partners' capacities to cope with the stress of the disease. Severity of the disease, attachment tendencies, and couple satisfaction were tested as predictors of EE. DESIGN: The design was cross-sectional. Couples (N = 61) were interviewed 2 weeks after the women's breast surgery. METHODS: Expressed emotion was assessed in women and in partners with the Five-Minute Speech Sample, with a focus on overt and covert criticisms. Self-reported EE, attachment tendencies, and couple satisfaction were assessed with questionnaires. Hierarchical regression analyses were performed to test the predictors and possible interactions between them. RESULTS: Both partners expressed overt and covert criticisms; women expressed more overt criticisms than did their partners. Cancer stage was inversely related to the number of overt criticisms in women and to the number of covert criticisms in partners. Regression analyses showed that in women, higher attachment anxiety and lower couple satisfaction were positive predictors of overt criticisms; in partners, a higher cancer stage was a negative predictor of overt and covert criticisms. CONCLUSIONS: Practitioners should pay attention to the couple relationship in breast cancer. EE is most likely to appear when the cancer stage is low, showing that even when the medical prognosis is optimal, relational and emotional disturbances may occur. Statement of contribution What is already known on this subject? The couple relationship is of paramount importance in breast cancer. Expressed emotion (EE) is related to negative individual and relational psychological outcomes in psychiatric and somatic diseases. Expressed emotion has not yet been studied in the context of breast cancer. What does this study add? Expressed emotion is present in breast cancer situations, especially when the cancer stage is low. There was more EE in women than in their partners. Cancer stage, attachment tendencies, and couple satisfaction are predictors of EE.

Distress and body image disturbances in women with breast cancer in the immediate postsurgical period: The influence of attachment insecurity.

The aim of this study was to assess, in the immediate postsurgical period, the influence of attachment avoidance and anxiety on distress and body image disturbances in women facing breast cancer. Seventy-five women participated in the study 3 weeks after surgery. Questionnaires were used to assess study variables. To predict distress and body image disturbances, we controlled for several variables known to influence adjustment to the stress of breast cancer. The results of hierarchical regression analyses show that attachment explains the outcomes above and beyond other influential variables. Insecurely attached women are especially vulnerable to the stress of the disease.