Effectiveness of Discharge Education Plan for Patients’ Care Practices and Anxiety Levels Post-Mastectomy: A Quasi-Experimental Study Self-care and anxiety levels post mastectomy
Abstract
Background: Breast cancer poses a major public health concern, particularly among elderly women, due to its high incidence and psychological burden. Effective nursing interventions are crucial for minimizing complications, improving psychological well-being, and enhancing self-care practices post-mastectomy. The aim of this study was to assess the effect of a discharge education plan on self-care practices and anxiety levels among post-mastectomy patients.
Methods: A randomized clinical trial was conducted at the Oncology Center in Damanhur Governorate, Egypt, including 80 elderly female patients undergoing modified radical mastectomy. Participants were randomly assigned to either the study group (n=40, receiving a discharge education plan) or the control group (n=40, receiving routine care). Data collection involved structured assessments of sociodemographic and clinical profiles, self-care practices, and anxiety levels pre- and post-intervention.
Results: Baseline self-care and anxiety levels were comparable between groups. Post-intervention, self-care practice scores significantly improved in the study group (mean = 85.6 ± 7.2) compared to the control group (mean = 62.3 ± 10.1, P<0.001). Anxiety levels significantly decreased in the study group (mean = 2.78 ± 0.77) versus the control group (mean = 6.90 ± 2.00, P<0.001). The study group's mean self-care practice score (353.9 ± 9.2) was significantly higher than that of the control group (265.3 ± 36.9, P<0.001), reinforcing the effectiveness of the intervention.
Conclusion: The discharge education plan significantly enhanced self-care practices and reduced anxiety levels among post-mastectomy geriatric patients. The statistical significance of these improvements (P<0.001) underscores the intervention’s efficacy, demonstrating its vital role in post-operative recovery and psychological well-being.
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References
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-49. doi:10.3322/caac.21660.
Iacoviello L, Bonaccio M, de Gaetano G, Donati MB. Epidemiology of breast cancer, a paradigm of the "common soil" hypothesis. Semin Cancer Biol. 2021;72:4-10. doi:10.1016/j.semcancer.2020.02.010.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70(1):7-30. doi:10.3322/caac.21590.
Gopalani SV, Janitz AE, Campbell JE. Cervical Cancer Incidence and Mortality among Non-Hispanic African American and White Women, United States, 1999-2015. J Natl Med Assoc. 2020;112(6):632-8. doi:10.1016/j.jnma.2020.06.007.
World Health Organization (WHO). Data visualization tools for exploring the global cancer burden in 2022. Geneva, Switzerland: WHO; 2023.
Ferlay J, Colombet M, Soerjomataram I, Parkin DM, Piñeros M, Znaor A, et al. Cancer statistics for the year 2020: An overview. Int J Cancer. 2021. doi:10.1002/ijc.33588.
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424. doi:10.3322/caac.21492.
Bjerkeset E, Röhrl K, Schou-Bredal I. Symptom cluster of pain, fatigue, and psychological distress in breast cancer survivors: prevalence and characteristics. Breast Cancer Res Treat. 2020;180(1):63-71. doi:10.1007/s10549-020-05522-8.
Cipora E, Konieczny M, Karwat ID, Roczniak W, Babuśka-Roczniak M. Surgical method of treatment and level of satisfaction with life among women diagnosed with breast cancer, according to time elapsed since performance of surgery. Ann Agric Environ Med. 2018;25(3):453-9. doi:10.26444/aaem/91586.
Tsaras K, Papathanasiou IV, Mitsi D, Veneti A, Kelesi M, Zyga S, et al. Assessment of Depression and Anxiety in Breast Cancer Patients: Prevalence and Associated Factors. Asian Pac J Cancer Prev. 2018;19(6):1661-9. doi:10.22034/apjcp.2018.19.6.1661.
Mishra A, Nair J, Sharan AM. Coping in Post-Mastectomy Breast Cancer Survivors and Need for Intervention: Systematic Review. Breast Cancer (Auckl). 2023;17:11782234231209126. doi:10.1177/11782234231209126.
Howell D, Harth T, Brown J, Bennett C, Boyko S. Self-management education interventions for patients with cancer: a systematic review. Support Care Cancer. 2017;25(4):1323-55. doi:10.1007/s00520-016-3500-z.
Bonetti L, Tolotti A, Anderson G, Nania T, Vignaduzzo C, Sari D, et al. Nursing interventions to promote patient engagement in cancer care: A systematic review. Int J Nurs Stud. 2022;133:104289. doi:10.1016/j.ijnurstu.2022.104289.
Jiang YS, Shi H, Kang YT, Shen J, Li J, Cui J, et al. Impact of age-friendly living environment and intrinsic capacity on functional ability in older adults: a cross-sectional study. BMC Geriatr. 2023;23(1):374. doi:10.1186/s12877-023-04089-5.
Zhang LF, Chen J, Shang C, Zhou J, Xiong W. Effect of PBL-based health education on lymphedema and cancer related fatigue and shoulder joint motion in patients underwent modified radical mastectomy. Int J Clin Exp Med. 2020;13(6):4544-52.
Shachak A, Jadad AR. Electronic health records in the age of social networks and global telecommunications. JAMA. 2010;303(5):452-3. doi:10.1001/jama.2010.63.
Koçan S, Gürsoy A. Body Image of Women with Breast Cancer After Mastectomy: A Qualitative Research. J Breast Health. 2016;12(4):145-50. doi:10.5152/tjbh.2016.2913.
Rushton M, Howarth M, Grant MJ, Astin F. Person-centred discharge education following coronary artery bypass graft: A critical review. J Clin Nurs. 2017;26(23-24):5206-15. doi:10.1111/jocn.14071.
Kang E, Tobiano GA, Chaboyer W, Gillespie BM. Nurses' role in delivering discharge education to general surgical patients: A qualitative study. J Adv Nurs. 2020;76(7):1698-707. doi:10.1111/jan.14379.
Leifer R, Bristow B, Puts M, Alibhai S, Cao X, Millar BA, et al. National Survey Among Radiation Oncology Residents Related to Their Needs in Geriatric Oncology. J Cancer Educ. 2019;34(1):9-13. doi:10.1007/s13187-017-1244-1.
Boquiren VM, Esplen MJ, Wong J, Toner B, Warner E. Exploring the influence of gender-role socialization and objectified body consciousness on body image disturbance in breast cancer survivors. Psychooncology. 2013;22(10):2177-85. doi:10.1002/pon.3271.
Mustafa M, Nornazirah A, Salih F, Illzam E, Suleiman M, Sharifa A. Breast cancer: detection markers, prognosis, and prevention. IOSR J Dent Med Sci. 2016;15(08):73-80.
Demers AA, Saint-Jacques N, Ellison L, Brenner D, Fitzgerald N, Aziz S, et al. Update on cancer incidence trends in Canada, 1984 to 2017. Health Promot Chronic Dis Prev Can. 2022;42(7):301-5. doi:10.24095/hpcdp.42.7.04.
Cline ME, Herman J, Shaw ER, Morton RD. Standardization of the visual analogue scale. Nurs Res. 1992;41(6):378-80.
El Sakhy N. Effect of applying Peplau's interpersonal relations model on the preoperative anxiety level among geriatric patients undergoing cataract surgery. Phd Thesis Thesis: Alexandria University; 2015.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68(1):7-30. doi:10.3322/caac.21442.
Qaseem A, Lin JS, Mustafa RA, Horwitch CA, Wilt TJ, Forciea MA, et al. Screening for Breast Cancer in Average-Risk Women: A Guidance Statement From the American College of Physicians. Ann Intern Med. 2019;170(8):547-60. doi:10.7326/m18-2147.
Zhuo Q, Ma F, Cui C, Bai Y, Hu Q, Hanum AL, et al. Effects of pre-operative education tailored to information-seeking styles on pre-operative anxiety and depression among patients undergoing percutaneous coronary intervention: A randomized controlled trial. Int J Nurs Sci. 2023;10(2):174-81. doi:10.1016/j.ijnss.2023.03.015.
Speyer CL, Nassar MA, Hachem AH, Bukhsh MA, Jafry WS, Khansa RM, et al. Riluzole mediates anti-tumor properties in breast cancer cells independent of metabotropic glutamate receptor-1. Breast Cancer Res Treat. 2016;157(2):217-28. doi:10.1007/s10549-016-3816-x.
Gautam AP, Maiya AG, Vidyasagar MS. Effect of home-based exercise program on lymphedema and quality of life in female postmastectomy patients: pre-post intervention study. J Rehabil Res Dev. 2011;48(10):1261-8. doi:10.1682/jrrd.2010.05.0089.
Kilbreath SL, Refshauge KM, Beith JM, Ward LC, Lee M, Simpson JM, et al. Upper limb progressive resistance training and stretching exercises following surgery for early breast cancer: a randomized controlled trial. Breast Cancer Res Treat. 2012;133(2):667-76. doi:10.1007/s10549-012-1964-1.
Bandura A. Social foundation of thought and action: A social cognitive theory. United States: Prentice-Hall, Inc.; 1986.
Sawant A, Keall P, Pauly KB, Alley M, Vasanawala S, Loo BW Jr, et al. Investigating the feasibility of rapid MRI for image-guided motion management in lung cancer radiotherapy. Biomed Res Int. 2014;2014:485067. doi:10.1155/2014/485067.
Caruso R, Nanni MG, Riba MB, Sabato S, Grassi L. The burden of psychosocial morbidity related to cancer: patient and family issues. Int Rev Psychiatry. 2017;29(5):389-402. doi:10.1080/09540261.2017.1288090.
Bozkurt C, Erbay-Dalli Ö, Yildirim Y. The effectiveness of reminiscence therapy on anxiety, depression, and quality of life in adult cancer patients: a systematic review and meta-analysis. Support Care Cancer. 2024;32(11):728. doi:10.1007/s00520-024-08920-6.
Taso CJ, Lin HS, Lin WL, Chen SM, Huang WT, Chen SW. The effect of yoga exercise on improving depression, anxiety, and fatigue in women with breast cancer: a randomized controlled trial. J Nurs Res. 2014;22(3):155-64. doi:10.1097/jnr.0000000000000044.
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