Research

The Lived Experience Of Postoperative Mastectomy Patients Receiving Healing Touch

By: Valerie S. Eschiti, PhD, RN, CHTP, AHN-BC
Betty Ann Baker, LMT, CHTP

Despite remarkable advances and decreases in mortality in breast cancer treatment, surgery, chemotherapy, and radiation produce distressful after-effects for post-operative mastectomy patients. Such treatment, as well as a diagnosis of cancer, may cause anxiety that in turn may increase levels of pain. Pain and anxiety exist as two major issues for women after mastectomy. After-effects of surgery may hamper vitality and quality of life for breast cancer survivors. Many seek other therapies in order to relieve symptoms and gain a sense of control during their treatment and recovery.

One of the therapies women find helpful is Healing Touch (HT). Potential Benefits of HT include reduced pain , increased relaxation, increased calmness, improved breathing, stress relief, increased energy, overall comfort, spiritual benefit ,mood improvement , becoming more comfortable with oneself during the healing process , a sense of unity and connectedness during this difficult experience and reaching out for assistance to meet the challenges that are faced. HT may facilitate a feeling of caring and holism.

All of these benefits should improve quality of life for these women, and help them to achieve the sense of control they desire. Costs for certain medications, such as narcotics and anxiolytics, also could be potentially be decreased, since women may find relief from pain and anxiety facilitated by receiving HT.

Aims
The aims of this pilot study were to describe the thoughts and feelings of women who are receiving HT within six months following a mastectomy, and to determine study feasibility. The information gained contributes to an understanding of the women's lived experience that may serve as helpful information in developing strategies for improving the quality of their lives. It also provides recommendations for conducting a full study. The long-term goal is to develop and test an intervention that will improve the quality of care for women after undergoing a mastectomy—a time when they may suffer detrimental after-effects from treatment for breast cancer.

Design
A feminist phenomenological design was employed. Although breast cancer also occurs in men, the disease decimates women's health with greater frequency. In the U.S. society, breasts are often viewed within a sexual context. As such, when mastectomy occurs, a woman's body image may be adversely affected. Therefore, the social and historical contexts in which breast cancer occurs in the U.S. have ramifications that support utilizing a feminist approach. It is important to view this experience through feminine lens, in order to fully understand the experiences of these women.

The operative word in phenomenological research is "describe". The aim of the researcher is to describe as accurately as possible the phenomenon, refraining from any preconceptions, and remaining true to the facts. Approval of the Cancer Institute Scientific Review Committee and Institutional Review Board (IRB) at the University of Oklahoma Health Sciences Center was obtained.

Methods
There were no known risks to participating in the study. It is possible that recalling surgery and treatment for breast cancer could bring up uncomfortable feelings for a woman. These feelings should be minimally distressing, and would likely dissipate while talking about them to the researcher, who would use therapeutic communication skills. If a woman felt distressed during the telephone interview, the researcher would ask her if she would like to end the interview. If she did, the researcher would then supply her with the name and contact information of a psychiatric nurse practitioner who could speak with her to assist her with her feelings. The woman would also be instructed to notify her physician of her distress. If the psychiatric nurse felt that a woman needed further professional assistance, the nurse would have referred her to the Oncology Counselor at Jupiter Medical Center. This did not occur with any participants.

Recruitment was provided through the Program Director of HT Buddies of Jupiter, Florida, Betty Ann Baker. HT Buddies program provides HT treatments to women free of charge for one year after diagnosis. For the recruitment process, flyers were posted in HT Buddies office and distributed in community. A flyer and contact permission sheet was posted on HT Buddies website. Potential participants contacted the Principal Investigator (PI) directly or through the Program Director –not their HT practitioner, so as not to feel pressured to participate.

Once PI received a woman's request to participate, informed consent forms were sent via postal mail to the potential participant, along with a self-addressed, stamped envelope in which to return the signed forms to the researcher. Participants were informed that their participation was voluntary, that potential benefits may outweigh the risks, and that they could withdraw at any time. Once the completed forms were signed and returned, the PI arranged a time with the participant for a telephone interview.

One semi-structured telephone interview was conducted with each participant by the PI using an interview guide. The PI could contact some participants for an additional interview if it seemed necessary to clarify more information. An open-ended approach to interviews was maintained in order to remain true to phenomenological methodology. Interviews were audiorecorded.

Demographic information collected was age, ethnicity, marital status, educational level, time since breast cancer diagnosis, time since mastectomy (included partial mastectomy -lumpectomy), length of time receiving HT, and occupation. One hour was allowed for telephone interviews—an interview guide was employed and probing questions were asked as needed. A $20 health food store gift certificate provide to participants to thank them for their time

Data were collected until February 2009, when 2 years of IRB approval expired, and recruitment had been occurring for 18 months. The researcher needed to continue collecting data until saturation of information occurs; this was estimated to be about 10 participants. This investigation served as a pilot study, as saturation of data was not achieved.

Sample
The sample consisted of 5 White women, ages 43-75 years of age; 3 were married, 1 widowed, and 1 divorced; 2 were retired, and 3 employed. Time since breast cancer diagnosis was 2-8 months. Time since mastectomy was 1-8 months (it took time to receive consents and arrange interviews). 3 women received a partial mastectomy; 2 received a full bilateral mastectomy. Length of time receiving HT was 1-7 months.

Findings
There were 4 major themes identified: Preparation for Surgery, Social Support, Healing (with subthemes of Physical, Mental, Emotional, and Spiritual Healing), and Practitioner Attributes (See boxes for exemplars).

Preparation for Surgery
Participant #1: "She [HT practitioner] gave me Healing Touch and she stayed with me until they took me down to the operating room. I felt very comfortable. I didn't feel stressed at all and I am probably not the calmest person in the world…I felt very relaxed…They [family] were angry with me because I didn't take a pill [Valium]. But I didn't have any problems if I were to tell you the truth. I was very comfortable."

Participant #2: "She [HT practitioner) was there as I was going into surgery, and she did it just before surgery. She got my blood pressure down. I mean way low and way calm. So I went in very calmly and I have a tendency for my blood pressure to shoot, you know, when I'm upset."

Social Support
Participant #1: "My husband-he rejected me. He wouldn't have anything to do with me. And if I didn't have Betty Ann, and people at the Cancer Group, I would have been lost…his first wife had an arm removed because of cancer, and I understood that. ..I think that it's a great support system."

Participant #2: "Since I am alone it made it so much incredibly easier for me to deal with."

Participant #4: "My Healing Touch buddy…was my best support system."

Healing Practitioner Attributes
Participant #1: "Betty Ann Baker is excellent, and kind, and you know she's caring. And I think that's what helps. ..I guess because I had confidence in the doctor, I had confidence in Betty Ann. The doctor, the surgeon, was very caring. You know, and all those things count when you're going through cancer."

Participant #4: "Having somebody who you feel is a real buddy of yours who you can become connected with who understands you and is there for you."

Suggestions for Future Research
Recommendations for future research include having a stronger recruiting strategy in place, possibly enabled by funding and/or larger population from which to draw a sample. The recruitment strategy and study design could draw upon other races/ethnicities in the population, e.g. flyers and interviews in Spanish language.

In addition, in-person interviews may facilitate collection of richer data. A researcher could arrange to interview participants again later in their treatment trajectory to compare across time. One might find it beneficial to conduct a longitudinal study so that participants can be followed over time.

A final consideration is the incorporation of probing questions that extend data collected from pilot study, e.g. Participant #4 stated, "I would wish that it would be made known to people that there was a better way to share with people…I don't know if the American Cancer Society would have informed me that such a thing was available."

Acknowledgements
This study was funded by a grant from Healing Touch International. Recruitment support was provided by HT Buddies of Jupiter, Florida. The authors extend sincere gratitude to the women who shared their experiences.

Contact Information
Valerie Eschiti: valerie-eschiti@ouhsc.edu
Betty Ann Baker: HTBuddiesInc@cs.com
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