The document discusses three research studies on the relationship between the type of cancer surgery information provided by physicians and the amount of anxiety experienced by patients. The first study found that patients who received more information about radiation therapy through an educational video reported less anxiety at the end of treatment compared to those who did not view the video. The second study found that breast cancer patients offered a choice in surgery and their husbands reported better psychosocial adjustment than those not offered a choice. The third study found no difference in psychiatric morbidity between patients who chose or did not choose their breast cancer treatment. Overall, two of the three studies supported the idea that more information from physicians is related to lower patient anxiety, while one study did not find a significant relationship.

1. Valerie Jaskiewicz
Section1
ResearchQuestion: What is the relationship of type of cancer surgery information
provided by physician and the amount of anxiety experienced?
Section 2
Bibliography Abstract 1 Agree with RQ:
Rainey, L.C. (1985). Effects of preparatory patient education for radiation oncology patients.
Cancer, 56(5), 1056-1061.
 Statement of Purpose:
o This study concerns the impact of an audiovisual patient education module on
cancer patient’s treatment-related knowledge and effective status during therapy.
The anxiety of the patient may also be a factor in how well the patient is able to
understand the information.
 Variables:
o Independent Variable(s) - Patients assigned to the high-information condition
were shown a 12 minute slide tape program. The low information group consisted
of patients who did not see the slide-tape program but instead simply underwent
current departmental procedures.
o Dependent Variable(s) - (1) the patient’s knowledge of radiation therapy and (2)
the patients emotional status and mood during the course of therapy. Each patients
knowledge of radiation therapy was assessed by a 21-item, objective
questionnaire developed for this study: the “radiation Therapy Questionnaire”
(RTQ). Anxiety level during the course of treatment was assessed by the “state”
form of the State/Trait Anxiety Inventory (a-State). A second broader affective
arousal indicator-Total Mood Disturbance (TMD) was obtained from the Profile
of Mood States.
 Hypothesis:
o H1: The more that a patient understands the information about their treatment
options the lower the amount of anxiety and drastic mood.
o H2: The less that a patient understands the information about their treatment
options the higher the amount of anxiety and drastic mood.
 ResearchQuestion(s):

2. o RQ 1: What is the relationship between type of radiation education program
viewed and the level of emotional distress?
 Methods:
o Subjects: 60 Sixty patients beginning their first course of radiation therapy
participated in the study. Participation was not restricted on the basis of disease
site or stage, other treatment history, specific type of radiation therapy being
administered, nor on the basis of any demographic variables. Men and women
were equally represented in the study; the average age was 50.8 years (range 21-
75).
o Procedure: Patients were assesses at two points: (1) at the beginning of radiation
therapy treatment, and (2) during the last week of treatment.
o Intervention Conditions: Patents were assigned to either of two intervention
conditions, each offering different levels of preparatory patient education. Patients
assigned to the high-information condition were shown a 12 minute slide tape
program that (1) introduces the personnel of radiation oncology department and
describes their professional roles;(2) shows various types of radiation therapy
equipment; (3) outlines the sequence of treatment procedures to which the patient
will be subjected; (4) explains what the patient will see, hear, and feel during
treatment; (5) presents basic information about how radiation therapy works; (6)
dispels common misconceptions (e.g., treatment itself is painful, the patient is
made “radioactive”); and (7) explicitly encourages patients to ask questions and
seek further information about radiation therapy. The low information group
consisted of patients who did not see the slide-tape program but instead simply
underwent current departmental procedures.
o Coping style measures: Two measures were used to classify coping style: the
Avoid- Vigilant Sentence Completion Test(SCT) and the Modified repression-
Sensitization Scale (RS). Consistent with earlier work, the two measures,
although conceptually similar, were found in the current study to be empirically
uncorrelated (r=-0.04).
 Results:
o There was, at the initial assessment (T₁)
 A statistically significant main effect for intervention group (i.e., High-
Versus low-information) on the objective measure of knowledge (RTQ).
The group receiving the patient education intervention show greater
accuracy of treatment-related knowledge than the nonintervention group.
However, the two groups did not differ significantly in affective status.
The high-information group did have lower State Anxiety (A State) and
Total Mood Disturbance(TMD) scores than did the nonintervention group,
but these differences did not reach a statistical significant.
o Results at the follow-up assessment (T₂)

3.  The analyses of variance show that at the close of treatment there was a
statistically significant main effect for intervention grouped by SCT
scores, the patients who received the patient education module reported
less State Anxiety (37.9 versus 43.6; P<0.05) and lower TMD (19.5 versus
41.2; P<0.005)for the intervention and control groups respectively.
o In brief, the findings at the follow-up evaluation show that patients who receive
the patient education intervention manifest significantly less affective distress and
anxiety, regardless of coping style.
Bibliography Abstract 2 Agree with RQ:
Morris, J.,& Ingham, R. (1988). Choice of surgery for early breast cancer: psychosocial
considerations. Social Science and Medicine, 27(11), 1257-1262.
 Statement of Purpose:
o A prospective study was conducted with early breast cancer patients who had either
been offered, or not been offered, a choice of surgery for treatment. The choice
involved mastectomy or wide excision plus radiotherapy. Available evidence suggests
that the medical outcome between these two options is similar; this study was
designed to investigate selected psychosocial outcomes.
 Variables:
o Independent Variable(s)-
 Differences in aspects of psychosocial adjustment between breast cancer
patients (and their husbands) are offered a choice of surgery of the breast
cancer patient, and those not offered a choice.
o Dependent Variable(s)-
 Using semi-structured interview schedules designed for this study,
information was obtained about the perceptions of the process of diagnosis
and treatment, and the reported impact of the disease on:
 (a) social activities
 (b) marital relationships
 (c) work carried out inside and outside the home.
o Future plans and coping.
 Levels of anxiety and depression were obtained from:
 The Hospital Anxiety and Depression Scale,
 Self-esteem from the Rosenberg Self-Esteem Scale,
 Physical and psychological symptoms from the Rotterdam Symptom
Checklist.
 Hypothesis:
o H1: The dyads (husband and wife) will feel more stress when given no choice to their
(wife’s) treatment of breast cancer.
o H2: The dyads (husband and wife) will feel less stress when given a choice to their
(wife’s) treatment of breast cancer.
 ResearchQuestion(s):

4. o RQ: What is the relationship between the type of surgical choice offered and the level
of psychological complaints?
 Methods:
o 30 Participants
 There were 20 patients and 12 husbands in the choice group; 10 patients and 7
husbands in the no choice group. Results from independent t-tests
demonstrated that the patients who chose mastectomy were significantly older
than the other patients, as were their husbands. Of the 20 patients offered a
choice of surgery, 13 chose wide excision plus radiotherapy and 7 chose
mastectomy. Patients who chose mastectomy largely did so because they
wanted the whole area containing the cancer removed, or to avoid
radiotherapy. Those who chose wide excision did so to preserve the breast and
undergo a less drastic surgical procedure; radiotherapy for these patients was
commenced approximately 4 weeks post-operatively and given on 5 days a
week for 5 weeks.
o The breast cancer (all T1/2NOMO) patients were interviewed on the day prior to
surgery, thereafter at 2-monthly intervals for the first 10-12 months post-operatively.
Data were collected from patients’ husbands pre-operatively, 2, 6 and 10 months
postoperatively.
o The two groups arose because patients with centrally located tumors were not offered
a choice of surgery-at the time of the study it was the policy of the surgeons at the
hospital concerned to perform mastectomy for such patients.
 Similar findings were obtained for the husbands of the two groups. All
patients (breast cancer and controls) were managed by two consultant
surgeons with a special interest in breast disease.
 Results:
o Social Activities:
 Insignificant change reported.
o Marital Relationship
 No changes in quality of their sexual relationship but the patients not offered a
choice reported a loss of interest.
o Work, future and coping.
 Pre-operatively, more of the patients not offered a choice of surgery felt that
their work had been impaired as a consequence of the cancer diagnosis (If =
5.76, d.f. = 1, P c 0.01). Similarly, at 10 months post-operatively more of the
patients offered a choice of surgery were able to undertake the work to the
same degree as they could prior to diagnosis (H = 4.76, d.f. = I, P < 0.05).
 Additional results indicated that the patients not offered a choice of surgery
felt more anxiety about the future 2 months (H = 4.38, d.f. = 1, P c 0.05) and
10 months post-operatively (H = 4.17, d.f. = 1, P < 0.05).
o Level of anxiety and depression
 Questionnaire data Results from the Hospital Anxiety and Depression Scale
have been reported elsewhere.

5.  Self-Esteem Scale. There were no significant differences between groups.
 Rotterdam Symptom Checklist. Data were analyzed using the Mann-Whitney
test. Results from three subscales are presented: physical complaints,
psychological complaints, and severe toxicity. At 2 months for physical
complaints were 6.0 for the group given a choice and 10.5 for the group not
given a choice; median scores were 5.0 and 5.5 respectively.
o The results from this study suggest that patients offered a choice of surgery, and their
husbands, adjust more readily to the cancer experience in terms of psychosocial
functioning than do patients, and husbands, not offered a choice of surgery. Improved
reported adjustment was found with respect to the ability to undertake work, attitudes
towards the future, beliefs about coping, less anxiety in choice patients versus non-
choice, and in physical and psychological functioning.
Bibliography Abstract 3 Disagreewith RQ:
Fallowfield, L. J., Hall, A., Meguire, .G.P, & Baum, M. (1990). Psychological outcomes of
different treatment policies in women with early breast cancer outside a clinical trial.
British Medical Journal, 301(9), 575- 580.
 Statement of purpose:
o To assess outside a clinical trial the psychological outcome of different treatment
policies in women with early breast cancer who underwent either mastectomy or
breast conservation surgery depending on the surgeon's opinion or the patient's
choice.
 Variables:
o Independent Variable(s)- Surgery and radiotherapy or adjuvant chemotherapy, or
both, depending on the individual surgeon's stated preferences for managing early
breast cancer.
o Dependent Variable(s)- Anxiety and depression as assessed by standard methods two
weeks, three months, and 12 months after surgery.
 Hypothesis:
o H1: When using a pragmatic study the psychological impact of women's knowledge
or ignorance that they were in a clinical trial.
o H2: Determine whether the extent of psychiatric morbidity reported in women who
underwent breast conservation surgery or a mastectomy was associated with their
participation in a randomized clinical trial.
 ResearchQuestions:

6. o What is the relationship between choice of treatment/surgery that is either chosen by
the patient or physician and the amount of psychiatric morbidity or anxiety
encountered during treatment?
 Methods:
o Patients-269
 Women under 75 with a probable diagnosis of stage I or II breast cancer who
were referred to 22 different surgeons.
o On admission to hospital those women eligible for inclusion were given a letter
inviting them to participate in the project, together with a consent form and three self-
assessment questionnaires to be completed preoperatively. Psychiatric morbidity,
sexual functioning, and social adjustment were assessed using the same methods as in
the breast conservation study.
 Self-assessment questionnaires-The hospital anxiety and depression scale,
Rotterdam symptom checklist, and Spielberger state/trait anxiety inventory
were given to the patients preoperatively and at two weeks, three months, and
12 months postoperatively.
 Semi structured psychiatric interviews-A shortened version of the present
state examination25 was conducted by a trained interviewer about two weeks,
three months, and 12 months postoperatively.
 Results:
o A significant effect of surgeon type on the incidence of depression was observed,
with patients treated by surgeons who offered a choice showing less depression than
those treated by other surgeons (p= 006). There was no significant difference in
psychiatric morbidity between women treated by surgeons who offered a choice who
were eligible to choose their treatment and those in the same group who were not able
to choose.
 Odds ratios for anxiety in patients treated by surgeons favoring mastectomy,
lumpectomy or a choice were 1.0, and 0.57 and 0.22 respectively; odds ratios
for depression were 1.00, 0.55 and 0.30. Anxiety: <0.01, Depression <0.06.
o There is still no evidence that women with early breast cancer who undergo breast
conservation surgery have less psychiatric morbidity after treatment than those who
undergo mastectomy. Women who surrender autonomy for decision making by
agreeing to participate in randomized clinical trials do not experience any different
psychological, sexual, or social problems from those women who are treated for
breast cancer outside a clinical trial.
Section 3
RestatedResearchQuestion:What is the relationship of type of cancer surgery
information provided by physician and the amount of anxiety experienced?

7. My Answer basedon results:
The more information provided by a physician to the patient the less anxiety the patient
will experience. Research from Rainey (1985) was the most rewarding to the research question.
When patients know more about the treatments and how the process is going to work the patients
know what to expect. Cancer will always produce some sort of anxiety, since the patient does not
know the outcome, but with more knowledge of the treatment, the lower the anxiety.
Section4
Cancer will produce some form of anxiety to any cancer patient and loved ones. When a
patient is diagnosed of a cancer, the patient usually wants to do something but are not sure what
to do at times. This is a scary part of the cancer patients lives and the outcome could be death.
The patient knows that something must be done to stop the cancer. Most anxiety is greatest
before, and during treatment. When a physician gives the patient an idea of what to expect during
treatment, a patient will rely on the physician’s knowledge to guide them through this difficult
process. Patients do not know what the outcome will be, the more information that a physician
provides to the patient the lower amounts of anxiety will be experienced.
Everyone will react to cancer differently; some patients want to choose the treatment and
some patients prefer a physician to recommend treatment/ surgery. Rainey (1985) research is one
of the reasons why the research question above is correct. The fear of the unknown will create
anxiety to a patient that has never experienced cancer treatment before. When the participants
who were shown the educational videos of what to expect, the patients would know what is
going to happen. Fear of the unknown was depleted when the patient would receive the exact
same treatment that was on the educational video. However, fear of the unknown is still
prevalent in the participants who did not go through the educational video. The patient does not
know what to expect. Freedom of choice is the second reason why the research question is

8. correct. When a patient’s life is in the hands of a choice of treatment, the patient wants to make
sure the choice is the correct treatment for that patient’s needs.
Morris & Ingham (1988) researched the difference in dyads when given a choice and no
choice of the patient’s treatment. If a physician favors a certain treatment, the patient is likely to
use that treatment. The patients are given a choice to use the recommended treatment. However,
there are patients who are given no choice in the treatment. The third and final reason is that
surgery and treatment of the patients are life changing. Some treatments/ surgeries can affect the
patients’ lives forever. The more that a patient understands about the treatment/surgery the more
likely they will cope with the dramatic change. The more that a patient understands the effects of
the choices that physicians provide the less anxiety they will experience. One of the three
researches did not support the research question. This research claimed that anxiety levels were
not significant. It measures the psychological outcomes of different treatment policies in women
with early breast cancer outside a clinical trial. The research also claimed that the more
information that was provided to the patient by the physician resulted in an increase in anxiety.
This particular study made the research question obsolete. The effect of surgery of women with
breast cancer should have an anxiety level. Women who decide to receive either a mastectomy or
a lumpectomy had depression levels that were high at the beginning of surgery and then low at
the end of the treatment. This particular study had an amazing amount of information that
seemed to reach the wrong conclusion. Cancer patients will experience some kind of anxiety
before, during and after treatments and surgeries. This theoretic rational of having more
information leading to less anxiety seems prevalent in the first two studies. When the fear of the
unknown is eliminated, the patient will succumb to a sturdy decision in the course of the
treatment. The first study proved that patients who receive the patient education intervention

9. manifest significantly less affective distress and anxiety, regardless of coping style. The second
study suggest that patients offered a choice of surgery, and their husbands, adjust more readily to
the cancer experience in terms of psychosocial functioning than do patients, and husbands, not
offered a choice of surgery. These studies prove that when a patient is given a choice of their
treatment the patients are not sure what to do. Rainy (1985) reportSCT scores, the patients who
received the patient education module reported less State Anxiety (37.9 versus 43.6; P<0.05) and
lower TMD (19.5 versus 41.2; P<0.005) for the intervention and control groups respectively.
This study was the most convincing. It proves the difference between same treatment options but
different ways to educate the patients. When the physician removes the fear, the patient will
experience less anxiety.
Section5
Bibliography:
Fallowfield, L. J., Hall, A., Meguire, .G.P, & Baum, M. (1990). Psychological outcomes of
different treatment policies in women with early breast cancer outside a clinical trial.
British Medical Journal, 301(9), 575- 580.
Morris, J.,& Ingham, R. (1988). Choice of surgery for early breast cancer: psychosocial
considerations. Social Science and Medicine, 27(11), 1257-1262.
Rainey, L.C. (1985). Effects of preparatory patient education for radiation oncology patients.
Cancer, 56(5), 1056-1061.