Understanding normality: a qualitative analysis of breast cancer patients concepts of normality after mastectomy and reconstructive surgery
ABSTRACT As survival rates increase, many people have to adjust to life after cancer. This includes adjusting to life after surgery. While previous research suggests that patients commonly strive to be 'normal' after mastectomy and reconstructive surgery, research surrounding individual perceptions of normality is lacking.
The aim of this study was to explore concepts of normality within a sample of breast cancer patients eligible for reconstructive surgery following mastectomy.
A total of 35 semi structured interviews, with women who had undergone or were about to undergo breast reconstructive surgery following breast cancer, were analysed using thematic analysis.
Four main themes emerged from the data. Women referred to looking normal (appearance); being able to fulfil everyday activities (behaviour); adapting to a new normal (reconstructing normality); and not being ill (health). The importance placed on each area of normality differed between patients. Additionally, patients used different standards to anchor concepts of normality. These included individual standards, social standards and clinical standards.
The results indicate that although there are commonalities between patients' concepts of normality, it is important for health care professionals to recognise potential individual differences. This may usefully aid communication and help to manage expectations among patients considering surgical options.
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ABSTRACT: The concept of normality in orthodontic diagnosis and treatment is defined from the clinicians' point of view or derived from concepts developed from observation of "ideal" persons. In-depth appreciation of what a patient views as normal is paramount for effective shared decision making. In this study, we aimed to examine the concept of dentofacial normality in orthodontics from the patient's perspective. This was a qualitative study of adults attending for orthodontic consultations at a teaching hospital. Semistructured interviews were conducted until data saturation occurred (n = 15). The data were managed using a framework approach, and recurrent themes were identified. Three main themes were identified in the interviews: the components of dentofacial normality, the impact of dentofacial abnormality, and factors influencing patients' conceptualization of dentofacial normality. The components of normal appearance are apparent in the views of potential adult orthodontic patients. These ideas are formed from personal observations in conjunction with the external influences of family, friends, and the commercial media. There was a biopsychosocial impact of dentofacial abnormality with both enacted and felt stigma playing substantial roles. A normal dentofacial appearance cannot be solely constructed from measureable biologic variables. Patients view normality in terms of features that are acceptable biologically, psychologically, and socially, and there is significant overlap in these domains. Clinicians should be aware that traditionally held concepts of what they believe to be normal or abnormal might not fully represent patients' beliefs.American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 03/2014; 145(3):287-95. DOI:10.1016/j.ajodo.2013.11.016 · 1.33 Impact Factor
Psychological Studies 09/2014; 59(3):289-298. DOI:10.1007/s12646-014-0251-0
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ABSTRACT: OBJECTIVE: Spiritual well-being (SpWB) is integral to health-related quality of life. The challenges of colorectal cancer (CRC) and subsequent bodily changes can affect SpWB. We analyzed the SpWB of CRC survivors with ostomies. METHODS: Two-hundred-eighty-three long-term (≥5 years) CRC survivors with permanent ostomies completed the modified City of Hope Quality of Life-Ostomy (mCOH-QOL-O) questionnaire. An open-ended question elicited respondents' greatest challenge in living with an ostomy. We used content analysis to identify SpWB responses and develop themes. We analyzed responses on the three-item SpWB sub-scale. RESULTS: Open-ended responses from 52% of participants contained SpWB content. Fifteen unique SpWB themes were identified. Sixty percent of individuals expressed positive themes such as "positive attitude", "I am fortunate", "appreciate life more", and "strength through religious faith". Negative themes, expressed by only 29% of respondents, included "struggling to cope", "not feeling 'normal' ", and "loss". Fifty-five percent of respondents expressed ambivalent themes including "learning acceptance", "an ostomy is the price for survival", "reason to be around despite suffering", and "continuing to cope despite challenges". The majority (64%) had a high SpWB sub-scale score. CONCLUSIONS: Although CRC survivors with ostomies infrequently mentioned negative SpWB themes as a major challenge, ambivalent themes were common. SpWB themes were often mentioned as a source of resilience or part of the struggle to adapt to an altered body after cancer surgery. Interventions to improve the quality of life of cancer survivors should contain program elements designed to address SpWB that support personal meaning, inner peace, inter connectedness, and belonging. Copyright © 2013 John Wiley & Sons, Ltd.Psycho-Oncology 11/2013; 22(11). DOI:10.1002/pon.3318 · 4.04 Impact Factor