Types of participants
This review will consider studies that include women with a breast cancer diagnosis of any type or stage, with the exception of a cancer recurrence. Women with a recurrence will be excluded since the experience of recurrence has been shown, through research, to be dissimilar to the experience of the first diagnosis and treatment of the disease. The experience of women in all treatment modalities will be included (i.e. lumpectomy, mastectomy of all types with or without breast reconstruction, chemotherapy, radiation therapy and hormone therapy).
This review will consider studies that include age as a primary area of interest in the study design. That is, the study will focus on: 1) younger women or older women, or 2) a psychosocial issue and compare it across the lifespan from younger to older. The definition of “younger” and “older” will not be described by the reviewers prior to the review because no consensus has been reached in the literature about defining “young” and “old” in cancer. However, this will be observed in the studies and reported on in the analysis. Therefore, studies that identify the participants as “young” and/or “old”, and provide a range of ages of the participants, will be included. Studies will be excluded if they do not define their population(s) by age or if they combine younger and older populations together.
Phenomenon of interest
The phenomenon of interest is women's psychosocial experience of breast cancer, including the social, psychological, emotional, spiritual and quality-of-life aspects of cancer.
This review will include women from all geographical regions. It will also include all cancer care contexts (e.g. acute care hospital, ambulatory care setting, home care, primary health care).
Types of studies
This review will consider studies that focus on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research.
The search strategy aims to find both published and unpublished studies. A three-step search strategy will be utilized in this review. An initial limited search of MEDLINE and CINAHL will be undertaken, followed by an analysis of the text words contained in the title and abstract, and of the index terms used to describe the articles. A second search using all identified keywords and index terms will then be undertaken across all included databases. Thirdly, the reference lists of all identified reports and articles will be searched for additional studies. Studies published in English will be considered for inclusion in this review. Studies published from 1990 to the present will be considered for inclusion in this review based on the timeframe in which psychosocial research in breast cancer began.
The databases to be searched include:
MEDLINE, CINAHL, PsychINFO, SCOPUS, EMBASE (European literature), Web of Science, Google Scholar, ProQuest
Initial keywords to be used will be:
Breast cancer OR breast carcinoma; AND
Psychosocial experience OR psychosocial distress OR psychosocial impact
Assessment of methodological quality
Qualitative papers selected for retrieval will be assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) (Appendix I). Any disagreements that arise between the reviewers will be resolved through discussion, or with a third reviewer.
Qualitative data will be extracted from papers included in the review using the standardized data extraction tool from JBI-QARI (Appendix II). The data extracted will include specific details about the populations, study methods and outcomes of significance to the review question and specific objectives.
Qualitative research findings will, where possible be pooled using JBI-QARI. This will involve the aggregation or synthesis of findings to generate a set of statements that represent that aggregation, through assembling the findings rated according to their quality, and categorizing these findings on the basis of similarity in meaning. These categories are then subjected to a meta-synthesis in order to produce a single comprehensive set of synthesized findings that can be used as a basis for evidence-based practice. Where textual pooling is not possible, the findings will be presented in narrative form. One challenge in this review is the synthesis of different age groups. This will be done by observing the age ranges in the articles and aggregating the findings for each age group in order to distinguish similarities and differences in the groups. It is expected that these age groups will show some variation between articles. However, because this review is looking at ‘younger’ and ‘older’, there is not likely to be an overlap in the age groups (adding a third ‘middle-aged’ group would be more complicated and therefore is not being considered in this review).
Conflicts of interest
There are no conflicts of interest.
Ms Campbell-Enns holds a Canadian Institutes of Health Research (CIHR) Fredrick Banting and Charles Best Canada Graduate Doctoral Award.
Dr Woodgate is a Canadian Institutes of Health Research (CIHR) Applied Chair in Reproductive, Child and Youth Health Services and Policy Research.
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Appendix I: Appraisal instruments
QARI appraisal instrument
Appendix II: Data extraction instruments
QARI data extraction instrument