How nurses support the emotional impact of reconstructive surgery

Question

How can breast care nurses support the women experiencing the emotional impact of reconstructive surgery after breast cancer treatment?

Answer

In a recent article (The Times, 2016a), television presenter Sian Williams describes how she became ‘paranoid’ when returning to work that signs of her recent reconstructive surgery following treatment for breast cancer would be visible, and that people would somehow be able to see her physical wounds.
In common with many women, Sian found the illness, treatment and her double mastectomy extremely traumatic (Chan, 2010), and opted for reconstruction as part of her recovery.
Lamp and Lester (2015) emphasise the importance of breast reconstruction specialist nurse involvement in care both before and after mastectomy, throughout which the patient can face a bewildering range of choices. They argue that reconstruction specialist nurses are often the best placed to provide the patient with information that meets their specific individual learning needs, takes into account their preferences, psychological and disease status and their support systems in order to provide individualised care, which is the essence of person centered nursing.
A large amount of evidence across a wide variety of health contexts supports person-centered care, which can be defined as that which involves mutual decision making between patients and clinicians with the goal of optimising quality of life and functional health (Coulter & Ellins, 2007). In a recent study, Temple-Oberle et. al., (2014) found that patient satisfaction with reconstructive surgery, and positive quality of life outcomes, such as improved self-esteem and body image, were improved with the provision of individually tailored pre-operative and post-operative education and care, which supports the value of nursing input highlighted by Lamp and Lester (2015).

References

Chan, L.K., 2010. Body image and the breast: the psychological wound. Journal of Wound Care, 19(4), pp.133-4.

Coulter, A. and Ellins, J., 2007. Effectiveness of strategies for informing, educating, and involving patients. Bmj, 335(7609), pp.24-27.

Lamp, S. and Lester, J.L., 2015. Reconstruction of the breast following mastectomy. In Seminars in oncology nursing (Vol. 31, No. 2, pp. 134-145). WB Saunders.

Temple‐Oberle, C., Ayeni, O., Webb, C., Bettger‐Hahn, M., Ayeni, O. and Mychailyshyn, N., 2014. Shared decision‐making: Applying a person‐centered approach to tailored breast reconstruction information provides high satisfaction across a variety of breast reconstruction options. Journal of surgical oncology, 110(7), pp.796-800.

The Times, 2016. Presenter reveals mastectomy angst [online] available at http://www.thetimes.co.uk/article/presenter-reveals-mastectomy-angst-3625l7mjq accessed 8th October 2016