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An Environmental Intervention to Restore Attention in Women With Newly Diagnosed Breast Cancer

Cimprich, Bernadine PhD, RN, FAAN; Ronis, David L. PhD


Earlier research indicated that attentional fatigue with reduced capacity to direct attention in women treated for breast cancer may be ameliorated by a theoretically based intervention involving regular exposure to the natural environment. This study tested the efficacy of a natural environment intervention aimed at restoring attention in 157 women with newly diagnosed breast cancer. Capacity to direct attention was assessed with a brief battery of objective measures at two time points: approximately 17 days before surgery (time 1) and 19 days after surgery (time 2). A randomly assigned intervention protocol was initiated after the first assessment and before any treatment. The intervention comprised a home-based program involving 120 minutes of exposure to the natural environment per week. The intervention group (n = 83) showed greater recovery of capacity to direct attention from the pretreatment (time 1) to the preadjuvant therapy period (time 2), as compared with the nonintervention group (n = 74). A significant effect of the natural environment intervention was observed even after control was used for the effects of age, education, attention scores at time 1, other health problems, symptom distress, and extent of surgery. The findings suggest therapeutic benefits for capacity to direct attention from early intervention aimed at restoring attention in women with newly diagnosed breast cancer.

From the University of Michigan (Drs Cimprich and Ronis); and the Department of Veterans Affairs (Dr Ronis), Ann Arbor, Michigan.

Supported by the National Institutes of Health, National Institute for Nursing Research, R29 NR 04132.

Corresponding author: Bernadine Cimprich, PhD, RN, FAAN, University of Michigan, 400 North Ingalls, Room 2172, Ann Arbor, MI 48109-0482 (e-mail:

Accepted for publication April 17, 2003.

© 2003 Lippincott Williams & Wilkins, Inc.