This paper presents a critical appraisal of two peer-reviewed studies examining same-day (outpatient) breast cancer surgery from a nursing perspective. The first study, by Greenslade, Elliott, and Mandville-Anstey (2010), uses qualitative thematic analysis to explore women's lived experiences of same-day breast cancer surgery, identifying themes of preparation, timing, support, and community health intervention. The second study, by Allard (2007), employs a randomized controlled design to evaluate the effectiveness of the Attentional Focus and Symptom Management Intervention (AFSMI) delivered by telephone in reducing emotional distress and improving post-operative functional status. Together, the appraisals highlight both the promise and limitations of same-day surgery for breast cancer patients and underscore the importance of individualized psychological assessment and targeted nursing interventions.
This report presents critical appraisals of two peer-reviewed studies focused on same-day (ambulatory) breast cancer surgery and its effects on women's physical and emotional well-being. The first study examines women's lived experiences through qualitative inquiry, while the second evaluates a telephone-based psychoeducational nursing intervention using a randomized controlled design. Together, these appraisals inform evidence-based nursing practice for oncology patients undergoing outpatient surgical procedures.
Reference: Greenslade, M., Elliott, B., & Mandville-Anstey, S. (2010). Same day breast cancer surgery: A qualitative study of women's lived experiences. Oncology Nursing Forum, 37(2), E92–97.
Author credibility: All three authors are nurse educators holding PhDs who teach at nursing schools. The article is academically credentialed and peer-reviewed.
Country of study: Canada
Aim and objectives: To develop a better understanding of the ways in which women experience same-day breast cancer surgery, and to make recommendations that will assist healthcare professionals in effecting change and improving quality of care.
Study design: Thematic analysis of audio-taped interviews with 13 participants.
Method: A constructivist approach using interviews and comparative analysis; data were systematically reviewed and cross-tabulated for themes and connecting issues.
Study setting: Home, hospital, and clinic office settings.
Sampling method: Interviews were conducted only with women who consented to participate and had undergone same-day surgery.
Appropriateness of sample: Appropriate for a qualitative study. The small sample (n = 13) is not intended to support broad extrapolation, nor is the study longitudinal or exhaustive. The findings are suggestive of directions for further research.
Results (credibility, transferability, dependability, and confirmability): Several notable themes emerged: preparation, timing, support, and community health intervention. Most participants reported positive experiences; same-day surgery was less stressful for many, with little or no post-operative issues. The data suggest that not every patient is an appropriate candidate for same-day surgery — not simply physically, but psychologically as well (see also Harmer, 2011).
Ethical considerations: Established ethical guidelines were followed. The study assessed a specific population based solely on their experiences with day surgery.
Relative strengths: The study is admittedly qualitative in scope. The literature review is robust, and the research attempts to bring greater clarity to the effects of day surgery for a specific condition within a specific population. The research is professional, and results are logical and presented fairly.
Relative weaknesses: The article is not exhaustive, and findings are not necessarily extrapolated to a broad population. A larger demographic sample and a longitudinal basis would strengthen future research in this area.
Application to nursing practice: Nurses across all areas need to understand how the day-surgery patient may respond to preparation, surgery, and recovery. The findings apply to all nurses who may care for day-surgery patients.
Conclusion: Same-day surgery is becoming increasingly common in the context of cost containment and managed-care healthcare concerns. The issues surrounding such surgery indicate that the healthcare system must be more responsive to change. Breast cancer surgery is often traumatic and requires that each patient be clinically reviewed for appropriateness. This is particularly true for women who are highly anxious or have co-existing conditions that may contribute to anxiety or other negative feelings following the surgical procedure (Taghian, Smith, & Erban, 2010).
Reference: Allard, N. (2007). Day surgery for breast cancer: Effects of a psychoeducational telephone intervention on functional status and emotional distress. Oncology Nursing Forum, 34(1), 133–141.
Author credibility: Allard is a professor in Health Sciences and holds both an RN designation and a PhD.
Country of study: Canada
Aim and objectives: To determine the effectiveness of a nursing intervention based on self-regulation theory — specifically the Attentional Focus and Symptom Management Intervention (AFSMI) — designed to support the emotional well-being of women who had undergone day surgery for breast cancer.
Study design: A randomized clinical block trial; the control group comprised 56 participants and the study group 61 participants.
Method: The study group received AFSMI during two telephone sessions: one conducted 3–4 days after surgery and a second 10–11 days after surgery.
Study setting: Five regional medical centers within the Quebec, Canada service area.
Sampling method: 117 patients with primary breast cancer, all of whom had same-day surgery as part of their treatment.
Appropriateness of sample: Appropriate for the circumstances under consideration.
Results (credibility, transferability, dependability, and confirmability): The study found significant differences between the control and experimental groups in terms of post-surgery mood, confusion, tension, and home management.
Ethical considerations: All ethical considerations, including privacy protections, were followed. The study was conducted professionally.
Relative strengths: The study is peer-reviewed and provides a strong sense of the issues surrounding pain, fatigue, and emotional disturbances following surgery.
Relative weaknesses: While the sample is larger than that of the previous study, it remains limited in scope and offers limited demographic, psychographic, and geographic extrapolation.
Application to nursing practice: Using any intervention that helps patients after traumatic surgery is beneficial — especially when it allows patients to express emotions, anxiety, and their stages of healing. Short-term telephone intervention using the AFSMI technique proves quite helpful in most cases. This finding was also corroborated by other studies (Yarbro et al., 2010).
Conclusion: Statistical analysis showed that AFSMI was effective in reducing emotional distress and enhancing post-operative physical conditioning.
"Integrated findings and nursing practice implications"
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