Anxiety, coping strategies, and coping behaviors in patients undergoing head and neck cancer surgery.

BACKGROUND: Little is reported in the scientific literature about the modulating effect of anxiety on the coping process before and after surgical treatment for head and neck cancer. OBJECTIVES: The major purpose of this article is to describe the relationships among preoperative anxiety and use of coping strategies, and postoperative self-care and resocialization behaviors in patients who sustain facial disfigurement/dysfunction with head and neck cancer surgery. METHODS: Using a prospective descriptive design, 75 (N = 75) adults who were about to sustain facial disfigurement and dysfunction associated with head and neck cancer surgery were entered into the study. The State Trait Anxiety Inventory and the Ways of Coping Questionnaire were administered to the respondents. The Disfigurement/Dysfunction Scale and Coping Behaviors Score values were calculated by the investigator. RESULTS: Self-care and anxiety were significantly correlated on postoperative day 4 (r = 2.30; p < .05) and on postoperative day 5 (r = 2.35; p < .05). For the 3 days under study, the relationship between total self-care and anxiety became stronger on postoperative day 5 (r = 2.39; p < .01), indicating that self-care on postoperative day 4 is related to reduced anxiety on postoperative day 5. In other words, self-care appears to precede reduction in anxiety in this sample. Secondly, there was a negative relationship between self-care and anxiety that increased over the early postoperative period. CONCLUSIONS: This study prospectively documents anxiety in surgical head and neck cancer patients. The findings suggest that at a specific point in time (postoperative day 5), self-care precedes reduction in anxiety, and that this negative relationship increases over time. Additional investigation is now critical in order to describe long-term recovery after surgical treatment for head and neck cancer and to develop appropriate interventions to meet the unique needs of this population.

Body image and quality of life after head and neck cancer surgery.

OBJECTIVES: The purpose of this paper is to describe the process of body image reintegration as it relates to quality of life in the surgical head and neck cancer patient. MATERIALS AND METHODS: To illustrate the course of body image reintegration after head and neck cancer surgery, the results of two major studies are presented. In the first study, a cohort sample of 75 adults about to undergo disfigurative surgery for head and neck cancer was examined to determine levels of anxiety before and after the procedure. The State Trait Anxiety Inventory was administered before and after surgery on postoperative days 4 through 6. In the large study, from which the cohort sample was derived, 117 adults about to undergo disfigurative surgery were investigated to determine the relationship between coping with surgical disfigurement/dysfunction and length of hospital stay. The Ways of Coping Checklist was administered before surgery. Disfigurement/dysfunction, as measured by the Disfigurement/Dysfunction Scale, and postoperative coping behaviors, as measured by the Coping Behaviors Score, were accounted for in both samples. Self-care and resocialization behaviors were observed and measured on postoperative days 4 through 6. RESULTS: In the cohort study, anticipation of disfigurative facial surgery was associated with extremely high levels of anxiety. In the large sample, coping effectiveness was diminished. The degree of surgical deficit ranged from mild to severe disfigurement and dysfunction. Preoperative coping effectiveness predicted postoperative coping behavior. It was concluded that body image reintegration was characterized by self-care, resocialization, and reduced anxiety. Further, that these components, when taken together, constitute assimilation of the surgical defect into self. CONCLUSIONS: Body image reintegration is critical to subsequent quality of life after head and neck cancer surgery. When disfigurement/dysfunction is associated with treatment, quality of life may be profoundly and adversely affected. Findings from the studies presented indicate a significant correlation between postoperative self-care and reduction in level of anxiety. The implications of this findings are important to care during the early period after surgery and to long-term follow-up after hospital discharge.

Otorhinolaryngology nursing research priorities: results of the 1996/1997 SOHN Delphi survey.

This study was initiated by the Society of Otorhinolaryngology and Head-Neck Nurses, Inc. (SOHN) to establish research priorities for the specialty. Otorhinolaryngology (ORL) Nurses were asked to identify, rate, and rank priorities for ORL nursing research. The survey sample was gleaned from attendees at the 20th Annual SOHN Congress and Nursing Symposium plus a follow-up mailing to active SOHN members who did not attend. A decision-making method, the reactive delphi technique, was employed. Four rounds of soliciting opinions by questionnaires were completed. Data from each round were reviewed and analyzed by three ORL nurse investigators. The respondents were largely actively employed, female SOHN members who were seasoned nurses, experienced in ORL nursing. The majority were Registered Nurses (RN) or held Bachelor of Science (BSN) degrees. They were primarily employed as staff nurses in outpatient settings and working with a general otorhinolaryngology patient population of all ages. The fourteen priorities identified fall in the areas of patient outcomes (three), patient education (three), symptom management (two), patient self-care (two), psychosocial issues (two), and nursing care delivery (two), spanning the practice spectra of all ORL nurse generalists and subspecialists. The top five research priorities identified are; care of neck stomas and related equipment, quality of life in head and neck cancer patients, impact of managed care on ORL nursing care delivery, value of ORL specialty nurses/nursing units, and effective techniques to promote cessation of substance abuse in adolescents. This priority identification provides a baseline for the newly forming SOHN Foundation.

Research attitudes of otorhinolaryngology clinicians: results of the 1996/1997 SOHN Delphi Survey. Society of Otorhinolaryngology and Head-Neck Nurses.

This paper reports the research experience and attitudes of respondents in the Society of Otorhinolaryngology and Head-Neck Nurses (SOHN) Delphi Survey of Otorhinolaryngology (ORL) Nursing Research Priorities. Questions on past experience with research and highest academic level achieved were included in the demographic section of the survey. A Research Attitudes Scale (RAS) was developed, validated, and administered. Results indicate that survey respondents were relative novices to the research arena but had positive attitudes about nursing research (group X = 6.2). Research attitudes scores decreased as scale items became more personal. A discussion of the SOHN Research Committee's structure and activities, as well as suggestions for additional study of SOHN members' research attitudes are offered based on the literature review and study findings.

Coping with disfigurement/dysfunction and length of hospital stay after head and neck cancer surgery.

The purpose of this study is to determine if an individual's use of coping strategies prior to sustaining facial disfigurement/dysfunction is predictive of coping effectiveness after head and neck cancer surgery. The specific aims of the study are as follows: (1) describe the relationship between demographic data, preoperative coping strategies, severity of disfigurement/dysfunction, postoperative healing progress, and length of postoperative hospital stay; (2) describe the relationship between demographic data, preoperative coping strategies, and postoperative coping behaviors; (3) determine the relationship between postoperative coping behaviors and length of hospital stay. The Stress-Coping Model of Scott, Oberst and Dropkin (1980) provides the theoretical framework for this study. The sample consisted of 117 adults who were about to undergo head and neck cancer surgery associated with disfigurement/dysfunction. Zero-order correlations were computed among the variables, including preoperative use of coping strategies, degree of postoperative disfigurement/dysfunction, postoperative coping behaviors, postoperative complications, and length of hospital stay. Multiple regression analyses were conducted on the major outcome variables: length of stay and postoperative coping behaviors. Gender (female), preoperative radiation therapy, preoperative chemotherapy and postoperative problems were found to significantly increase length of stay. The 16 predictors in this study contributed to 56% of the variance in length of stay. Fifteen predictors accounted for 25% of the variance in postoperative coping.

Coping with disfigurement and dysfunction after head and neck cancer surgery: a conceptual framework.

The relationship between coping effectiveness and degree of postoperative disfigurement and dysfunction has been described. Current nationwide mandates for more cost-effective health care warrant continued efforts to describe this patient population in relation to coping patterns. Those patients who do not cope adequately should be considered for more intensive intervention while still in the therapeutic environment of the hospital. More creative and innovative solutions are needed to facilitate effectiveness of intervention and predictability of outcomes within an appropriate time frame and in a fiscally responsible manner. In the interim, inability to cope with disfigurement and dysfunction at discharge can predispose the patient to infection or noncompliance with follow-up care, pathological obsession with or denial of the defect, depression, and social isolation.

Scaling of disfigurement and dysfunction in postoperative head and neck patients.

The primary purpose of this investigation was to construct a quantitative scale to measure the perception of severity of visible disfigurement and dysfunction following ablative head and neck cancer surgery. Facial disfigurement and disruption of physical function induced by head and neck surgery pose formidable obstacles to the medical and psychosocial adaptation of cancer patients. Although this problem is widely acknowledged, virtually no research has attempted reliable and valid measurement of such concepts. Consequently, the present study investigated the psychological perceptions of 100 registered nurses regarding 11 disfiguring surgical procedures and loss of associated functions. Results indicated that the nurses' judgments of disfigurement and dysfunction were highly consistent and not a function of patient gender. Judgments of the severity of disfigurement, moreover, were independent of the perceived severity of associated dysfunction. It was concluded that this is a reliable method for measuring the relative degree of disfigurement and dysfunction and represents a critical precursor to prediction of a patient's psychological rehabilitation and compliance with medical care after surgery.