Research utilizing theory, theoretical frameworks and models has generated a body of knowledge on coping strategies, adaptation to illness/disease, and health behaviors. Stress appraisal coping theory and frameworks have been utilized by researchers and have generated evidence-based knowledge for nursing practice (Norwood, 2000). Understanding stress and coping is essential to promoting health of women after breast cancer. Breast cancer is a stressor which affects health and other outcomes, Appraisal, coping and resources can impact health. Continued use and evaluation of theories and theoretical frameworks contributes to theoretical extensions and modifications. Using theory to guide research helps identify coping patterns which work/do not work and resources which promote health. Letting out emotions is related to better physical and psychological adjustment to breast cancer (Stanton et al., 2000). Spirituality and social support resources reduces stress in women with breast cancer (Hebert, et al., 2009). Research suggests that escape-avoidance coping is a maladaptive strategy leading to poor outcomes like more psychological distress.
Lazarus and Folkman’s stress appraisal coping theoretical framework guided the study. Individuals’ responses to breast cancer are influenced by their subjective appraisals of the situation and current coping. Resources strengthen individuals against perceived harmful losses and threats related to the breast cancer situation. Appraisal, coping, resources can impact health outcomes after breast cancer. Primary appraisal is judgement about the significance of breast cancer as stressful, positive, challenging, benign or irrelevant. Secondary appraisal is the assessment of coping resources and options and what can be done about the situation. Primary and secondary appraisals are mediated by coping strategies (Lazarus and Folkman, 1984). Breast cancer may be perceived as a threat, harmful loss, challenge or seen as a positive experience, as women may grow and learn from the experience (Carver and Antoni, 2004).
The impact of a stressor is mediated by the person’s appraisal of the stressor and the psychological, social, and cultural resources available to them. When experiencing breast cancer, women evaluate threat and harms (primary appraisal) and the ability to change the situation and address negative emotional reactions (secondary appraisal). Coping is utilized to solve problems and manage emotions which result in outcomes like physical and psychological health. Extensions of coping theory suggest negative and positive emotions co-occur during the same time period.
Methods: Women aged 29 to 80 (n=47) having mastectomy or lumpectomy surgery were referred by surgeons and nurse interviewed before surgery. Measures: Appraisal of Breast Cancer; Ways of Coping Revised; Assessment of Resources; Profile of Mood States.
Results: Perceived causes of breast cancer included: poor eating habits; eating too much meat; not caring for oneself; taking estrogen; stress; breast injury. Breast cancer was appraised as a challenging experience with harmful losses. Older women had more positive appraisals than younger women. African-Americans had more beneficial-positive appraisals than Caucasians (t=2.80,p=.008). Women reported learning new things, changing risky lifestyle behaviors, becoming closer to family. Coping used: staying active/work; prayer; changing/growing; planning; sharing feelings; seeking advice; acceptance. Resources were: social supports, religion/spirituality, cultural practices, independence, finances, goals, feeling in control, healthier lifestyles (balanced diets, reduced caffeine and alcohol, quitting smoking, exercising, regular breast care including mammograms and breast self-examination). African-Americans used more distancing coping, had less tension-anxiety/confusion/mood disturbance (t=-3.22,p=.002), more vigor (t=4.47,p<.001) than Caucasians. African Americans had more support from their church, stronger faith and reported being closer with God than Caucasians during their breast cancer experience.
Conclusion: Women used positive and negative appraisals, a variety of coping strategies and resources to promote health. African-Americans had more beneficial-positive appraisals and better emotional health. Implications focus on educating women about positive appraisals, coping strategies, resources, healthy lifestyles since they can affect health. The theoretical framework was supported and provides nurses guidance for promoting health of women through reappraisal of the breast cancer situation, lifestyle changes and developing evidence-based interventions for breast cancer. Findings have implications for advancing practice and research.
Using theory to guide research helps nurses identify coping patterns which work/do not work, and resources which promote health. Assessments of appraisal, coping, resources can impact nursing practice and coping interventions (Greenlee, et al., 2017). It is important to assess appraisal, ways of coping with breast cancer and perceived resources. These assessments can impact on nursing practice and interventions and are useful in designing coping strategy training to be included in interventions. Nurses can implement educational programs to help women appraise their breast cancer experience more positively, identify and use more adaptive ways of coping and resources, and modify coping skills to manage stress.