title: Treatment decision difficulties and post-operative distress predict persistence of psychological morbidity in Chinese women following breast cancer surgery.
abstract: BACKGROUND
  The patterns and determinants of longer-term psychological morbidity in women following breast cancer surgery have not been described for Chinese populations.
  
  
  METHODS
  Chinese women were assessed at 3-days, 4-months and 8-months following breast surgery, on treatment decision-making difficulty (TDMD), satisfaction with treatment outcome (E-OI), self efficacy (GSeS), optimism (C-LOT-R), consultation satisfaction (C-MISS-R), physical symptom distress (PSD) and psychological morbidity (CHQ-12) and compared using polynomial logistic models.
  
  
  RESULTS
  Of 303/405 women providing complete data, 33% received chemotherapy and 26% radiotherapy. GSeS, CLOTR and TDMD scores were moderate. Though the proportion of women meeting psychological morbidity case-criteria declined from 78% (95% Confidence Interval 73-83%) at Baseline to 64% (59-69%) at 8-months, almost 50% (44-54%) of women remained distressed over the 8-month period. After adjustment for demographic and clinical factors, severity of psychological morbidity at 4-months was predicted by PSD, disappointment and higher Baseline CHQ12, and among moderate/severe cases only, greater TDMD and pessimistic outlook. At 8-months, CHQ12 scores were predicted by PSD, Baseline CHQ-12, and difficulties with TDM.
  
  
  CONCLUSIONS
  TDM difficulties, early post-surgical psychological and physical symptom distress indicate risk for prolonged distress in Chinese women following breast cancer surgery.
authors.affiliation: The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors.forename: Wendy W T
authors.initials: WW
authors.lastname: Lam
authors.forename: Miranda
authors.initials: M
authors.lastname: Chan
authors.forename: Hung Wai
authors.initials: HW
authors.lastname: Ka
authors.forename: Richard
authors.initials: R
authors.lastname: Fielding
mesh_terms: D000223:Adaptation, Psychological; D000275:Adjustment Disorders / Q000208:ethnology* / Q000517:prevention & control; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000523:psychology / Q000601:surgery*; D002681:China / Q000208:ethnology; D003131:Combined Modality Therapy; D003657:Decision Making; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008408:Mastectomy / Q000009:adverse effects / Q000523:psychology*; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D012307:Risk Factors; D013315:Stress, Psychological / Q000208:ethnology* / Q000517:prevention & control