On the basis of Mishel's uncertainty in illness theory, Lazarus and Folkman's stress on appraisal and coping, and Herth's perspective of hope, this cross-sectional, correlational study was designed to examine the influence of uncertainty, stress appraisal, and hope on coping in 71 survivors of breast cancer. Uncertainty was measured by the Mishel Uncertainty in Illness: Community Scale, stress appraisal by the Stress Appraisal Index, hope by the Herth Hope Index, and coping by the Ways of Coping Questionnaires (WCQ).

Breast cancer survivors increasingly experience long-term side effects that influence their quality of life. They also experience uncertainty of their future due to recurrence of disease. Descriptive design was conducted. Using convenience sampling, 150 breast cancer survivors of more than 3 years from time of diagnosis were recruited from Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand. Research instruments included Mishel Uncertainty in Illness Scale, Stress Appraisal Index, Ways of Coping Questionnaire, and Quality of Life: Breast Cancer Version Questionnaire and Demographic Data Questionnaire. Results revealed that breast cancer survivors had moderate levels of uncertainty in their illness. Survivors appraised their illness and found high level of challenges, moderate level of threat, and low level of harm. Overall quality of life was found to be moderate. Among Ways of Coping strategies, seeking social support was used the most and confrontive coping was used the least. Using hierarchical multiple regression, variables influencing quality of life were year of survival, uncertainty in illness, and harm appraisal. All 3 variables explained 21.8% variance of quality of life. Uncertainty and harm appraisal influence quality of life in breast cancer survivors. Suggestions and further implications were included.

A qualitative study based on Heideggerian phenomenology was conducted with 17 Thai women who had survived breast cancer and had utilized at least one type of complementary therapy. The study explored the meaning of such therapy and the data were collected by an in-depth interview, a demographic data-recording form, and a reflective journal. The data were analyzed by using an interpretative process that was described by Cohen, Kahn, and Steeves. Six themes were generated in relation to the meaning of complementary therapy as perceived by the participants: cancer-controlling treatment; mental strengthening; mind and body therapy; self-determination; natural therapy; and conventional therapy integration. The knowledge gained from this study will help health-care providers better understand the role that complementary therapies play in the lives of women whose lives are threatened by cancer. It is important for health-care providers to be more proactive in the culturally sensitive promotion of using complementary therapies based on the women's values and preferences.

To determine whether a nurse-led breast screening educational program in the workplace improved the breast screening practices and attitudes of women. Worksites are potentially cost-effective and convenient for breast cancer screening education due to their ability to educate several women at one time. This was a collaborative study between industry, university and health services in Australia and Thailand. This was a pre post test group comparative design. Three worksites in Australia and three in Thailand were assigned to one of three groups: treatment (group education), pamphlet only, or control. All groups were assessed pre-education and again 3 months post-education on breast screening attitudes and practices using a mail-out self-report questionnaire. Women were significantly more likely to practice breast self-examination (BSE) following group education, and were more confident in their ability to detect a breast lump. There was a significant increase in breast screening discussion on the workplace for the Thai group following the group education program. An increase of 25% more women saw having a mammography as a priority. The Thai women had less access to free mammographic screening. They also had more negative attitudes and poorer knowledge regarding BSE and physical breast examination (PBE) than the Australian group, with the education program having a more positive impact on them than the Australian group. Relative breast screening attitudes and practices for the treatment, pamphlet and control groups are also presented. This study provides educators and health promotion professionals with further information on the beliefs and practices of women working in both Australian and Thai industries about breast screening. Education programs such as this one can have a positive impact on attitudes and practices including increased likelihood and confidence in practising BSE, promoting women to have a PBE, and promoting discussion of breast screening at the workplace. The findings suggest that Australian women have greater opportunities to ensure their breast health than Thai women, and that there may be a greater need for programs such as this in countries such as Thailand.

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