Emotional Support Focused Nurse Directed Intervention – Face to Face Confrontation on Serum Cortisol –A Dose Response Effect among

Breast Cancer Survivors

Sampoornam. W

Lecturer, PhD Scholar, Saveetha University, Chennai

Corresponding author Email: sampoornamwebster@yahoo.in

ABSTRACT:

Context: Nurses can support the breast cancer women well by listening to them, accepting their emotions and informing them in detail. Therewith, they can convey a sense of security to the women and help them to maintain hope and the ability to deal with reality.

Objectives: The purpose of this study was to investigate the efficiency of dose response effect with Emotional support focused nurse directed intervention on serum cortisol among breast cancer survivors.

Methods: 40 breast cancer survivors were checked with serum cortisol before and after the intervention. 20 participants in experimental arm and 20 in control arm were administered with Emotional support focused nurse directed intervention for the period of 30-45 minutes, five times in a week for three months which indicates the larger dose response effect in experimental arm and control arm received the same treatment thrice in a week to indicate the smaller dose response effect.

Results: Comparison of Paired t test value of pre and posttest serum cortisol scores between experimental arm and control arm showed 4.56 and 2.89 respectively which indicates the significance of Emotional support focused nurse directed intervention on serum cortisol.

Conclusion: Larger dose response could be effective than the smaller dose response with only minimal effectiveness for breast cancer survivors.

KEY WORDS: Emotional support, Nurse directed intervention, Serum cortisol, Dose response effect.

INTRODUCTION:

There are many ways to find help to cope with the emotional impact of breast cancer. Friends and family can offer support in the breast cancer journey. In fact, research conducted at the Cancer Support Community has shown that people who participate in support groups, either face-to-face or online, report significant decreases in depression, increased zest for life, and a new attitude toward their illness. Emotional support is important for most cancer patients during their illness and can be gained from different people and services. Emotionally, breast cancer, can be a tough time.

Often the emotional effects of a breast cancer diagnosis can last far longer than the physical ones and many women find they have a different attitude to life after breast cancer. In many cases, this can be a very positive thing. Most women with breast cancer face some level of emotional challenge both during and after treatment. Patients may worry about the possibility that the cancer will return, or may be concerned about changes in their physical health or psychological and social well-being.

Cortisol and catecholamines not only provide an objective indicator of stress-induced HPA and SNS activity and a means by which stress may impact breast cancer progression via immune modulation, but also a means by which psychological stress may have direct influences on mammary epithelium and tumor vascularisation.

Table 1: Frequency and Percentage distribution of pre and posttest serum cortisol scores of experimental arm

S.No	Level of Serum Cortisol	Pretest		Posttest
S.No	Level of Serum Cortisol	Frequency	Percentage	Frequency	Percentage
1.	Mild elevation	8	40	12	60
2.	Moderate elevation	9	45	7	35
3.	Severe elevation	3	15	1	5

In displayed table 1 experimental arm depicts that the posttest serum cortisol level has dropped down strongly when compared with pretest levels.

Table 2: Frequency and Percentage distribution of pre and posttest serum cortisol scores of control arm

S.No	Level of Serum Cortisol	Pretest		Posttest
S.No	Level of Serum Cortisol	Frequency	Percentage	Frequency	Percentage
1.	Mild elevation	6	30	9	45
2.	Moderate elevation	10	50	8	40
3.	Severe elevation	4	20	3	15

In displayed table 2 control arm depicts that the posttest serum cortisol level has dropped down weakly when compared with pretest levels.

Table 3: Comparison of mean and standard deviation of pretest and posttest serum cortisol scores between experimental arm and control arm

Arm	Pretest		Post test		Paired t test value
Arm	Mean	Standard deviation	Mean	Standard deviation	Paired t test value
Experimental arm	15.12	13.6	11.38	9.27	4.56
Control arm	16.4	15.89	14.56	12.23	2.89

Table value:- 2.093 P<0.05 Significant

Moran TJ, Gray S, Mikosz CA, Conzen SD. 2000. Women with advanced breast cancer who have abnormal daytime levels of cortisol, a hormone released in response to stress are significantly more likely to die sooner than patients with normal levels of the hormone. Ruthann Richter.2000.

Different doses or intensities of treatment wherein all subjects get some type of intervention but the experimental group gets an intervention that is richer, more intense or longer. This approach is often used when there is a desire to analyze dose response effects that is to test whether larger doses are associated with larger benefits or whether smaller dose would suffice. Polit. D., and Beck., (2008)

METHODS:

A total of 40 breast cancer survivors who had completed their routine treatments for at least three months were involved in the study at Erode Cancer Centre, Erode. Of 40 women contacted, all agreed to participate and completed the informed consent process. In vitro method was adopted to check the serum cortisol level during the evening at 18 hour. The participants were randomly placed in the experimental and control arm by undertaking the blue print on True experimental counterfactual dose response effect design. All study participants 20 in experimental arm and 20 in control arm had their blood analyzed with serum cortisol measured before and after the intervention.

One to one Emotional support focused nurse directed intervention consists of 7 sessions by making the participants to verbalize feelings and thoughts through face to face confrontation followed by informational support administered to the experimental arm for the period of 30-45 minutes, five times in a week for three months which indicates the larger dose response effect. Control arm received the same treatment thrice in a week to indicate the smaller dose response effect.

RESULT:

Characteristics of the experimental and Control arm ranged in age from 40 to 70 years (mean, 55 years), from 35 to 75 years (mean, 56 years) respectively. Most women were older than 50 years, had formal education, were employed, and had nil underage children. There were no statistically significant differences between the experimental and control arm in terms of their demographic and in clinical characteristics.

Table 3 Indicates that the serum cortisol posttest scores in experimental arm has reduced with maximum mean 11.38, + 9.27, while in control arm serum cortisol posttest scores has reduced with minimum mean 14.56, + 12.23. Comparison of Paired t test value of pre and posttest serum cortisol scores between experimental arm and control arm showed 4.56 and 2.89 respectively which indicates that larger dose response could be effective than the smaller dose response with only minimal effectiveness for breast cancer survivors.

DISCUSSION:

The major strength of the present study is counterfactual dose response effect design. The reporting of life events took place at baseline and thus was not susceptible to any selective remembering or reporting that might take place around the time of diagnosis among breast cancer survivors. The relation between life events and breast cancer risk could also have a hormonal basis, since stress-induced disruption of the functions of the neuroendocrine axes. Future studies are needed to confirm these findings on dose response effect and further researchers could explore the potential role of an individual’s behavioral and psychological coping styles in mediating or modifying the effects of life events due to the diagnosis of breast cancer.

REFERENCES:

1. Polit. D., and Beck., (2008) “Nursing research”(8^th ed) Lippincott William and wikins publisher

2. Moran TJ, Gray S, Mikosz CA, Conzen SD,(2000) “ The glucocorticoid receptor mediates a survival signal in human mammary epithelial cells” Cancer Research. 60:867–872.

3. Ruthann Richter, (2000) “Stress hormone may contribute to breast cancer deaths” JNCI Journal of the National Cancer Institute. Stanford Report.

4. Funch DP, Marshall JR, (1984) “Measuring life stress: factors affecting fall-off in the reporting of life events” J Health Soc Behav; 25:453–64.

5. Hilakivi-Clarke L, Rowland J, Clarke R, et al., (1993) “ Psychosocial factors in the development and progression of breast cancer” Breast Cancer Res Treat;29:141–60.

Received on 30.12.2014 Modified on 05.01.2015

Int. J. Nur. Edu. and Research 3(1): Jan.-March, 2015; Page 91-93

DOI: