Title : Effect of counselling on depression in patients undergoing mastectomy
INTRODUCTION: Breast cancer is the commonest malignant disease seen in women. Patients undergoing mastectomy face various psycho-social problems. Depression, depression, social problem and sexual problems are important problems encountered by these patients. Depression is one of the major difficulties faced by Mastectomy patients. Mastectomy is the surgical removal of one or both breast usually performed to remove a malignant tumor.
AIM : The objectives of the present study were to assess the extent of depression in patients undergoing mastectomy and to find out the effect of counseling on depression of patients undergoing mastectomy
Materials and Methods : This is an interventional study conducted in the Department of Surgery, Medical College Hospital, Thiruvananthapuram in two stages. During the first stage an instrument to assess depression was developed and validated. In the second stage patient counseling and teachings were given. The patients were assessed in the pre and post operative period. The sample size was 250, 125 patients as control an 125 patients as experimental. Counselling was given to 125 patients only.
RESULT: The mean depression score in the experimental group was reduced after intervention.
Depression Related to Disease and Treatment: Scores of worry about disease and treatment (mean difference 1.23), worry about surgery (mean difference 1.22), feeling helplessness following diagnosis of carcinoma breast (mean difference 0.86), disappointment about loss of breast (mean difference 1.40, worry about consequences of illness (mean difference 1.03), suicidal thought following diagnosis (mean difference 1.21); worry of recurrence and effectiveness of treatment (mean difference 1.23) and sadness following diagnosis (mean difference 1.23) and sadness following diagnosis (mean difference 1.23) and sadness following diagnosis (mean difference 1.57) were very much decreased following counselling. All these reductions in the depression level were statistically very highly significant (P<0.001)
Depression Related to Personal Factors: The study revealed that factors like worry about feeling unwanted (mean difference 1.00), worry about reduction in longevity of life (mean difference 1.30) worry about financial situations due to illness (mean difference 1.07), feeling of loneliness (mean difference 1.13), worry about reduced psychomotor activities (mean difference 1.6) were very highly significantly reduced following counseling (P<0.001). Worry about indifference to do activities (mean difference 0.10) was also reduced but not to statistically significant levels.
Depression Regarding Family and Society: The study indicates that scores of variables like lack of optimism about future (mean difference 1.57), reduction in communication and interaction (mean difference 1.91) and long hours of quietness (mean difference 1.30) were reduced very highly significant following counseling (P < 0.001)
Discussion: The results of a study of nurse patient communication before and after breast surgery and follow up showed that there were several areas of weakness in communication. They were inadequate explanation, of what to expect prior to surgery leading to patient depression, explanation given in medical terminology that confused patients, what changes are to be expected post surgery and inadequate involvement of family members. The nurses thought it to be their moral and professional duty, should act as advocates for the patient and family