EVIDENCE BASE NURSING

I. Clinical Question
In breast cancer patients; is mastectomy more efficient than BCS (Breast
Conserving Surgery) in and preventing psychological morbidity?
II. Citation
Factors that Affect Patients Decision-Making about Mastectomy or Breast
Conserving Surgery, and the Psychological Effect of this Choice on Breast
Cancer Patients
MahmutGumusBasak O. UstaaliogluMeralGaripEmreKiziltanAhmetBilici
MesutSekerBurcakErkolTaflanSalepciAlpaslanMayadagliNazim S. Turhal
Dept. of Medical Oncology, Dr. LutfiKirdar Research and Training Hospital,
Istanbul, Turkey
http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=2cf908cd-1848-4831ae16-6895020ede52%40sessionmgr10&vid=76&hid=13
III. Study Characteristics
Patients included
One hundred Turkish women with breast cancer who underwent
mastectomy orBCS, ages 30 to 80 years old, were followed up in the
Department of Medical Oncology in
the Dr. LutfiKrdar Research and Education Hospital between December
2007 and March 2008 participated in this study. There were 78 patients
who had undergone mastectomy and the 22 for BSC.
Interventions compared
It was reported that age and education were important for BSC
preference. Also, preference of the surgeon was a major factor influencing
the patients decision making. And inadequately informed patients chose
mostly mastectomy. Younger patients had greater concerns about body
image and sexuality.
Outcomes monitored
After surgery, 69 and 18 women who had undergone mastectomy
and BCS, respectively, had mild depressive symptomsaccording to BDI,
which were not serious enough towarrant psychiatric help.Although there

was no significantrelation between mastectomy or BCS and depression,

patientswith mastectomy had more evident depressive symptoms. Also,
there was no difference between the anxiety anddenial score between the
mastectomy and BCS group

Does the study focus on a significant problem in clinical practice?

Yes, the study focuses on a significant problem in breast cancer patients
psychological effect after they underwent mastectomy or BSC . This study
is to know how many does preferred mastectomy over BSC and estimate
the level of depression of the breast cancer patients after the mastectomy
or BSC procedure.
IV. Methodology/ design
Methods used
The focus groups in this are the Turkish breast cancer patients who have
undergone mastectomy or BSC. The patient are also to discuss their
knowledge about the following procedure, preferred procedure and different
emotional feeling after undergone mastectomy and BSC.
Design
This was a cohort, comparative study.
Setting
The study was conducted in Istanbul, Turkey
Data sources
We gathered the data on the internet specifically on EBSCOHOST.COM
Subject selection
Inclusion criteria
They included breast cancer patients only
Exclusion criteria
They excluded non breast cancer patients.
Has the original study been replicated?
There is no report that the study had been replicated.

 What were the risks and benefits of the nursing action or intervention
tested in the study?
Risks: The patient will not experience any risks in conducting this
research
Benefits: The study will help breast cancer patients to their choices.
V. Results of the study
After thepatients had answered the questions, responses were scored to detect
Psychological morbidities in these categories, and compared betweenthe
mastectomy and BCS group. Psychiatric symptoms were elicitedusing a
Structural Clinical Interview for DSM (SCID), and classified accordingto the
Diagnostic and Statistical Manual of Mental Disorders(DSM-III) criteria. SCID is
the gold standard clinical interview for researchdiagnosis of depression according
to DSM-III criteria. BDIwas used to evaluate the severity of symptoms of
depression; it was self-administeredand took 510 minutes. BDI is composed of
21 items and aquick screening instrument. It is used worldwide in both
psychiatric andnon-psychiatric patient populations. Beck et al. recommended
ascore of 10 when screening for mild depression, 16 for mild to
moderatedepression, 20 for moderate to severe depression, and 30 for
severedepression.Therefore,age, lactation, family history of breast cancer,
having had children, marital status, and consultation with a second surgeon were
important in the decision making process regarding breast cancer surgery in this
Turkish population. The fear of recurrence and non-curative outcome might have
outweighed cosmetic appearance in our patients so they mostly chose
mastectomy. As a result of our study, we feel that mastectomy did not cause
more psychosocial disturbance than BCS.
VI. Authors conclusion or recommendation
What contribution to clients health status does the nursing action or
intervention make?
It will help on patients preferences on what surgery would she likely to
underwent and make her choose possible appropriate choices that she
wantby providing adequate knowledge to the patient. Also, it will help to
decrease psychological morbidity among breast cancer patients.
What overall contribution to nursing knowledge does the study
make?
The overall contribution to nursing knowledge of this study is that, Nurses
must know that patients must be given adequate knowledge about their
disease and offer them different options that they easily pick what best for

them and ask them to share what they feel to prevent depression of the
patient after undergone certain procedure.
VII. Applicability
Does the study provide a direct enough answer to your clinical
question in terms of type of patients intervention and outcome?
Yes. It provides the direct enough answer to clinical question because it
providing adequate knowledge about mastectomy and BSC for a breast
cancer patient to help them choose the appropriate procedure.The study
also showed the different methods on how to measure the level of
depression of an oncology patientsIt also helps them to reduce patients
who are experiencing depression after the procedure.
Is it feasible to carry out the nursing action in the real world?
Yes, It is feasible to carry out because it is affordable, available, and
health promotive intervention to the client.
VIII. Reviewers Conclusion
Safety
Based on the study, BDI is composed of 21 items and aquick screening
instrument. It is used worldwide in both psychiatric andnon-psychiatric
patient populations. It is also important that physician must provide
adequate knowledge before performing proper procedure mastectomy and
BSC.
Acceptability
The study is acceptable. Many breast cancer patients have gone
mastectomy because of inadequate knowledge of BSC. It is important to
provide information for possible choices for the client to decide best
preferred procedure together with the physician and increase quality of life
of the patient.
Effectivenessand Appropriateness
The datas and information from the study are well accepted in the medical
field since it is actual and existing.The study shown, Psychological
distress, anxiety, and depression were found to be common in the range
of 1.546% among breast cancer patients, and psychological factors were
found to predict quality of life and overall survival in breast cancer. The
breast is considered a symbol of womanhood and sexuality, and having

breast cancer or receiving surgical treatmentis a traumatic experience for

a woman due to its impact on self-image.
Efficiency
It is efficient that a client know how to know their choices for them not feel
depress after underwent procedure. It is also important that depression
must be detected to improve quality of life to the breast cancer patients
and consultation with a second surgeon were important in the decision
making process regarding breast cancer surgery in this Turkish
population. The fear of recurrence and non-curative outcome might have
outweighed cosmetic appearance in our patients so they mostly chose
mastectomy. As a result of our study, we feel that mastectomy did not
cause more psychosocial disturbance than BCS.
Accessibility
Developing a broad based campaign about breast cancer patient will
enhance patients knowledge about what choices they want and to
diagnose early depression to improve quality of life.

EVIDENCE BASED
NURSING

Submitted by:
Manalo, Erilyn Leigh C.
BSN-309
Submitted to:
Prof. Christopher Evangelista