Jimmy J.

Luansing Go
IV- 5 RLE 2

Articles:
The Experience of Imagery as a Post-Treatment Intervention in Patients With Breast Cancer:
Program, Process, and Patient Recommendations. L. Freeman, L. Cohen et al.(2008).Oncology
Nursing Forum.

Expressive Writing in Women With Advanced Breast Cancer. M. Laccetti.(2007). Oncology

Nursing Forum.

Background:
I chose these articles in relation to my patient who has stage III breast cancer because of its
significance in the psychological and emotional effect of cancer towards the patient, which
would greatly influence her quality of life as well as her physical health. These studies will help
me improve in providing my patient with psychosocial care, allowing her to express any negative
feelings which may affect her wellbeing. In addition, the interventions proposed in these studies
would empower my patient to become more involved in her plan of care.

I. Problem Statement
Main Problem:
Does imagery and expressive writing affect a breast cancer patient’s wellbeing?
Sub Problems:
1. What are imagery and expressive writing and their mechanisms?
2. What are the benefits of these interventions?
3. Which of the two, imagery or expressive writing, is more feasible?

II. Research Methodology

The first study mentioned above utilizes a qualitative design to describe the experiences
of breast cancer patients who have undergone the intervention of imagery. Through a
random numbers table, 10 participants who were at least 6 weeks post- treatment of breast
cancer, were chosen to be interviewed, confidentially, about their imagery experiences using
key questions. Participants were asked to assume a teacher role so the interviewer could
learn from their imagery experience. These were tape recorded and transcribed then after
which, were reviewed to observe voice tone and emotional response to questions. The long-
table approach was used to identify themes.

The second study, on the other hand, uses a quantitative correlational study to determine
how a four- day expressive writing intervention affect breast cancer patients’ quality of life
three months after. 68 women with metastatic breast cancer, through convenience sampling,
were selected. The researchers used a “Linguistic Inquiry and Word Count” (LIWC) program
to identify in the writings patterns and number of affective words whether positive or negative.
The effect of expressive writing of patients was evaluated three months after through the
patients’ quality of life which was measured using the “Functional Assessment of Cancer
Therapy-Breast”. This compared the quality of life(QOL) baseline score and the QOL score 3
months after.

III. Summary of Findings

According to the study, imagery is a “technique for engaging the mind to create or
reframe mental and emotional representations of objects, places, or situations perceived
through and by the senses.” It includes passive, active and targeted imagery.
Passive imagery consists of the “preconscious and conscious images and emotions” of a
person affected by background noise and imagination. Active imagery is the “purposeful
 engagement” of emotionally supportive imagery to alter unpleasant and disturbing passive
imagery responses. Targeted imagery is the creation of a “biologic or physiologic process
image at optimal functionality with the goal of improving a health outcome”. On the other
hand, expressive writing is a method to facilitate disclosure through directed writing over
three or four consecutive days for 20-30 minutes each day.
Based on findings, these interventions alleviate the stress cancer patients are feeling
especially since many cancer survivors suffer long-term effects of their cancer treatments,
which negatively affect psychological well-being as well as quality of life. Imagery allows
patients to identify stressful images that they were visualizing daily, and replaced these with
emotionally supportive ones, and created biologically accurate images of optimal health.
Likewise, expressive writing translates distress into language to help people move beyond
negative experiences. Furthermore, these interventions allow reframing of life events which
may enhance patients’ acceptance and reduce their avoidance or denial.
Comparing the two, expressive writing entails a patient to enjoy writing in order for it to
become effective whereas imagery can be used easily without a paper and pen and it is not
time- consuming.

IV. Conclusion and Recommendations

Imagery and expressive writing does affect a breast cancer patient’s wellbeing, more so,
these improve the patient’s quality of life. It is recommended that nurses pay attention not
just to the physical health of the patient but also to the psychological health because health,
after all, is multidimensional and nurses should render patient- centered interventions like
these.

V. Implications
A. Nursing Practice
Nurses should apply these interventions more often with the rising number of cancer
patients confined everyday in the hospital. Knowing that their psychological wellbeing
would determine their quality of life, nurses must realize what these interventions can
actually do to transform negative perceptions and feelings of a breast cancer patient into
more helpful, fruitful positive thoughts.
Nurses would also be able to gain a deeper understanding of the patient’s status
because these facilitate communication between the nurse- patient relationship. Thus,
making it easier to identify the needs of the patient and plan nursing care.
B. Nursing Education
Student nurses, while in the course of their duty, should begin to understand and
train the use of these interventions so that they will mature into a more skilled and
compassionate nurse. It doesn’t take a mental health nurse to have that skill in
assessing a patient’s feelings.
C. Nursing Administration
Institutional managers and administrators should enforce in the health workplace the
use of these interventions to improve quality care to cancer patients. They should train
their staff how to apply imagery and expressive writing to increase the staff’s skill at the
same time, boost the reputation of nursing care given by the institution. Also, protocols
can be made to facilitate nurses in their attempts to implement them.
D. Nursing Research
More researches can be allotted to determine what is the best way or time to apply
these interventions. Future researchers can study about the effectiveness of
standardizing guidelines for imagery and expressive writing or about patient conformity
to these interventions.