Personal Narrative: A Difference In Breast Surgery
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A Personal Story 2
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Also, patients will have practical expectations of the treatment they may take. Thus, for patients with early stage breast cancer, DAs play a significant role in the treatment. In this review, we focused on all kinds of decision aids designed for use by patients. Some of these decision aid tools are used only by patients, others are used in a shared pattern by both clinicians and patients. The objective of this systematic review is to examine research on decision aids that specifically targets breast conserving surgery, one of the surgical options for early stage breast cancer patients.
A DA was defined as a tool which provided information about optional surgical method and relevant outcomes [ 9 ]. The format of DAs can be various, including video, audio, paper-based or multimedia. Articles were excluded if 1 they were not in English, 2 they were pilot studies, and 3 the full text of the study was not available. The search strategy was designed to be maximally inclusive see Appendix Table 2. The selection process of articles included in our systematic review was showed in Fig. After removing duplicate results, we screened titles and abstracts to identify potentially eligible articles. The full text of these articles was reviewed to list articles met our inclusion criteria. Finally, seven studies were included [ 10 , 11 , 12 , 13 , 14 , 15 , 16 ].
These articles were showed in following elements in Table 1 : authors, year of publication, design, sample, intervention, control, measurement tools, and outcomes. Four out of seven articles were randomized control trials RCTs , two were non-randomized trials with concurrent controls, and one was non-randomized trial with historical control. In three RCTs, patients were randomly assigned into two groups, which were intervention group and control group [ 10 , 11 , 13 ]. However, only one study explained the random assignment procedure clearly [ 11 ].
Most articles had inclusion and exclusion criteria in detail. Generally, eligible patients were newly diagnosed with early stage breast cancer and were suitable for either breast conserving surgery or mastectomy. However, the specific inclusive stage was different. The exclusion criteria were similar in these articles, such as non-malignant breast diseases, recurrent or metastatic breast cancer, poor health condition which could not tolerant surgical treatment, and mental disorder which could not cooperate during decision aids and measurements. Few articles had organized special team to select candidates. Wilkins et al.
The sample sizes ranged from 60 to However, only three articles explained the intended sample sizes and the power analysis of the trials [ 11 , 12 , 15 ]. Moreover, during the trials, there were quite a lot of patients got excluded, due to losing follow-up, poor cooperating, and unfinished questionnaires. While, no article compared the baseline of these patients with finally inclusive ones. Various patterns of decision aids were implemented in the intervention group, which led to the diversity of each corresponding control.
For most articles, patients in the intervention group were given educational materials via booklet, video or CDROM without assistance from surgeons. They could discuss with their friends and family members during decision making. While in two articles, instruments were presented by trained surgeons during the consultation, and patients could discuss with their surgeons and raise questions [ 14 , 15 ]. For patients in the control group, usual care and consultation were given. Some articles had brochure or written materials with similar information only in the written form [ 13 , 16 ]. As we can see in Table 1 , the measurement tools were different in each study, ranging from scales with examined reliability and validity, such as Decisional Conflict Scale DCS and Hospital Anxiety and Depression Scale HADS , to modified scales or self-made questionnaires.
In these studies, overall preference on surgical treatment was similar. Patients were more likely to receive breast conserving surgery, which showed the same trend as the statistics on surgical treatment for early stage breast cancer patients in the National Cancer Data Base [ 17 ]. After decision aids, some patients changed their choices. Among these studies, four of which showed that patients with decision aids were more likely to change their original choices into mastectomy or modified radical mastectomy [ 14 , 16 ].
While two studies had opposite results. Whelan et al. Street et al. The measurement tools were various questionnaires. Some articles showed that patients with decision aids had better knowledge than control group after the introducing, while no difference in follow-up assessments [ 10 , 13 ]. However, one study showed no significant difference in knowledge after decision aids and consultation [ 11 ]. Generally, patients in the intervention group had no less decisional conflict scores than the control group after consulting with surgeons [ 10 , 11 , 15 ]. Also, Lam et al. In addition, Street et al. The more knowledge they got, the more optimistic they would be. Unfortunately, few articles retrieved quality of life as outcome.
Molenaar et al. The purpose of this systematic review was to determine information requirement of patients diagnosed with early stage breast cancer facing a surgical choice and the role played by decision aids in the treatment decision making process. Generally, the contents of decision aids included background of breast cancer, introduction of treatment options, review of benefits and risks of each option, and personal values clarification.
This information could come from guidelines, recent researches, and surveys of surgeons and fellow patients. We found the final surgical option could be affected by decision aids. However, the influence was inconsistent. There were several explanations for this differentiation. First, two articles compared breast conserving surgery with modified radical mastectomy included patients with stage III breast cancer, who tended to choose mastectomy considering the possibility of recurrence.
Second, with the development of breast reconstruction, patients would probably choose mastectomy due to the cosmetic thoughts and lack of radiotherapy. Third, Chinese patients usually had smaller breasts than western women, which could be one possible reason for decreased breast conserving surgery. Last but not least, there could be risk of bias that some decision aids encouraged patients to choose specific surgical option rather than other alternatives. Although this kind of bias was not unacceptable in decision aids as long as the knowledge in decision aids was true and objective, this could be one of the reasons why the influence of decision aids on surgical options was inconsistent.
Other results such as knowledge of breast cancer and treatments, decisional conflict and satisfaction, psychological changes after surgery and quality of life were all showed with a better trend in the intervention group. Also, there were several aspects with no analysis, while we believed is necessary. First, the feasibility and completion rate of decision aids were not assessed. Similarly, Whelan et al. Jibaja-Weiss et al. Also, the pattern of decision aids was another factor influenced the feasibility and completion rate.
Although we found that information presented in different forms, such as written, visual and oral, could all be helpful, studies compared different forms showed that decision aids with pictures were much clearer for patients than only the words [ 18 , 19 ]. Second, the reliability and validity of those measurement tools were not tested, especially those modified scales and self-made questionnaires. Some modified scales were designed for specific kind of patients, which should be tested before using officially. We believe interdisciplinary cooperation with psychological department can help us more with the scales.
Today we got phone call from our doctor stating that she had cancer. I was in complete denial, until I realized that I had I stay strong for my best friend and help her through this tough moment in her life. Riley is the spitting image of me. Breast cancer is a cancer worse than what i had especially since she had to have chemotherapy. Chemo lowers your white blood cell count. White blood cells are what help you fight of diseases so she could easily get sick.
She did get sick and had to go to the hospital my dad went with her, and sense my brother was at college I had to go stay with my cousins in cairo so they could take me to school. I had to stay with them for about three weeks I always had to get up earlier than usual, and when I woke up my cousins woke up except for the eleven year old named grant who I would have to pick up out of his bed and take him to the kitchen so he could eat breakfast. Breast Cancer is a very close subject to my family. Every type of cancer breaks families apart every year.
I wish I could heal every person with cancer no one should have to go through this pain of losing a loved one. Breast cancer is an abnormal cell growing and infecting the cells around it. The cancer can start in the breast and spread to other parts of your body. When this happens, a cluster of cells form a mass of tissue called a lump or growth. Show More. Read More. Informative Essay: The Most Common Types Of Skin Cancer Words 3 Pages It is invasive because if it is not treated soon after it happens, it begins to spread to other skin cells and thus, other parts of the body, which can prove to be very deadly. Ataxia Telangiectasia Research Paper Words 4 Pages Many patients affected by ataxia telangiectasia are expected to develop some type of cancer.
I am eager to see how I can expand on this project and see what the future holds for me, my brother, my mom, and our family. I am pleased with conducting this experiment because it has truly bettered the bond…. So the cancer just kept growing over time. C the father of western medicine described breast cancer as a humoral disease. Supposedly the body consisted of 4 humors, blood, phlegm, yellow bile, and black bile. However many other doctors believe it was due to something else. Through the rest of the years many other doctors have been coming to the same conclusions. He served almost 40 years in schools. In , after the first heart attack he was struck by the second heart attack. This time the damage was serious and he almost got dead, the only possible way to save him was a bypass surgery.
My dad without fail within a day in old hospital, he started the process of transferring him to Surat another big city in Gujarat, India. Imagine being deadly-ill and needing a new organ to survive. But the list of people in need is topping , and there is only between 5, and 8, traditional deceased organ donors per year, the chance of you getting a new organ is very small. What are you going to do, die? For some people a solution is to buy an organ from the black market. Organ Transplants Doctors have been performing organ transplants since the year Organ transplantation is a very difficult task and requires a lot of training, skill, and patience. The first recorded organ transplant was performed on December 23, , it was performed on twin brothers, Ronald and Richard Herrick.
The doctor that performed this surgery was Dr. Joseph Murray. He was the Nobel winner for performing the first ever kidney transplant, and he died at the age of I am researching neurosurgery and everything that it takes to become a neurosurgeon. It takes extreme amounts of hard work and dedication to become a neurosurgeon.
