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Diagnosis and treatment of breast cancer affects women physically as well as psychologically. There are many obvious and real factors that are related to psychological distress in women coping with breast cancer, such as facing a life-threatening illness, painful and impairing treatments, and significant role changes. Although these factors are clearly important, issues related to body image in women faced with breast cancer can also add to psychological distress. Women, in general, are concerned with their appearance, their weight, and their body, with recent studies suggesting 89% of women reported concerns with weight. Such premorbid concerns are often deeply ingrained and can contribute to psychological distress in women treated for breast cancer. The present article is a summary of the literature that has examined body image issues and related psychological adjustment in women with breast cancer. Implications for clinical practice and recommendations for future investigations are discussed.

Purpose/Objectives The National Comprehensive Cancer Network’s Distress Thermometer (DT) has been adopted as a screening measure to identify and address psychological distress in individuals with cancer. The purpose of the present study was to establish an optimal cut off point in a large heterogeneous sample of cancer patients. A secondary purpose of the study was to examine whether distress as measured by the DT significantly changes across the treatment trajectory (i.e., diagnosis, on treatment, survivorship). Design The present investigation includes secondary analyses of baseline data from a longitudinal parent study examining a computerized psychosocial assessment. Setting Recruitment occurred at three diverse comprehensive cancer centers across the United States. Sample Eight hundred and thirty-six patients at 3 different comprehensive cancer centers with a current or past diagnosis of cancer were enrolled. Main Research Variables The BHS (Behavioral Health Status) index, as well as the DT were administered and compared using ROC analyses. Findings Results support a cutoff score of 3 on the DT to indicate patients with clinically elevated levels of distress. Further, patients who received a diagnosis within the 1-4 weeks prior to the assessment endorsed the highest levels of distress. Conclusions Providers may wish to utilize a cutoff point of 3 to most efficiently identify distress in a large, diverse population of cancer patients. Further, results indicate that patients may experience a heightened state of distress within the 1-4 weeks post-diagnosis as compared to other stages of coping with cancer. Implications for Nursing It is widely understood that nurses carry a heavy burden regarding patient care. It is often a nurse’s responsibility to screen for psychosocial distress, and using a brief technological measure of distress can help streamline this process.

Experiencing a negative consequence related to one’s health behavior, like a medical problem leading to an emergency department visit, can promote behavior change, giving rise to the popular concept of the “teachable moment.” However, the mechanisms of action underlying this process of change have received scant attention. In particular, most existing health behavior theories are limited in explaining why such events can inspire short-term change in some, and long-term change in others. Expanding on recommendations published in the 2009 Academic Emergency Medicine consensus conference on public health in emergency medicine, we propose a new method for developing conceptual models that explain how negative events, like medical emergencies, influence behavior change, called the Sentinel Event Method. The method itself is atheoretical; instead, it defines steps to guide investigations that seek to relate specific consequences or events to specific health behaviors. This method can be used to adapt existing health behavior theories to study the event-behavior change relationship, or to guide formulation of completely new conceptual models. This paper presents the tenets underlying the Sentinel Event Method, describes the steps comprising the process, and illustrates its application to emergency medicine through an example of a cardiac-related emergency department visit and tobacco use.