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Breast cancer (BC) is the most frequently cancer diagnosed and the leading cause of cancer death among women worldwide, including in Indonesia. Moreover, there is evidence that most women with BC in Indonesia are already in an advanced stage when starting BC treatment. When an early diagnosis is made promptly, BC may be detected at a potentially curable stage, improving survival and quality of life (QOL). Therefore, adherence to diagnostic procedures in addition to treatment is a significant public health issue. Interventions such as psychoeducation may encourage women with early BC symptoms to visit a medical doctor in time and to stimulate women with BC symptoms to continue the examinations so that the disease is timely diagnosed and treated. In addition, psychoeducation may reduce psychological distress (anxiety and depression), and improve QOL. For these purposes, we developed PERANTARA, a self-help psychoeducation that integrates medical and psychosocial contents. PERANTARA is an abbreviation for “Pengantar Perawatan Kesehatan Payudara”, which means an introduction to breast health treatment. This thesis addresses the following research questions: (a) Do QOL and health status of Indonesian women with BC symptoms differ from women in general? (addressed in chapter 2); (b) Does psychoeducation have a beneficial effect on adherence, BC knowledge, anxiety, depression, and QOL in each interval of BC care path? (addressed in chapter 3); (c) Is self-help psychoeducation feasible and acceptable for Indonesian women with BC symptoms? (addressed in chapter 5); and (d) Is self-help psychoeducation effective to reduce the time to diagnosis in women with BC symptoms, and, secondary, anxiety and depression while improving their BC knowledge, QOL and health status? (addressed in chapter 6). The studies presented in this thesis revealed that psychoeducation is a promising intervention to improve adherence to medical procedures and QOL, particularly in the diagnostic interval. However, the effects found for psychoeducation in this thesis must be interpreted with caution due to some methodological considerations, amongst others (a) the generalizability of our findings due to homogeneity of the study sample involved in our RCT; (b) the disadvantage of the cluster randomised crossover design that we implemented in our trials; and (c) the variation in the quality of included studies in our meta-analysis. For clinical practice, we recommend integrating psychosocial care, most notably psychoeducation, at all intervals of the BC care path. Future research may also investigate various strategies carried out by healthcare professionals, e.g., physicians, nurses, psychologists, or community health workers, to increase patient’s adherence and reduce physical and psychological problems. |
