Date of Graduation


Document Type


Degree Type



School of Nursing


Family/Community Health

Committee Chair

Susan McCrone

Committee Co-Chair

Susan Coyle

Committee Member

Stacey Culp

Committee Member

Hannah Hazard

Committee Member

Nan Leslie

Committee Member

Heidi Putman-Casdorph


Breast cancer is the most common cancer diagnosed in women and the leading cause of cancer deaths among women worldwide (Warner, 2011). Mortality from breast cancer in the United States has been decreasing in part due to advances in therapy and the detection of the disease at earlier stages. As a result, more than 1.6 million U.S. women will undergo a breast biopsy in 2013 with approximately 232,340 of these being diagnosed with cancer. Although distress in women undergoing a breast diagnostic evaluation has been recognized as having the potential to alter treatment outcomes in those diagnosed with cancer, few studies have explored the prevalence or predictors of distress in women undergoing diagnostic evaluations. The purpose of this study was to identify the prevalence of distress and identify predictors of distress during the breast diagnostic period. A convenience sample of 128 women (60.4%), aged 18-89 years, undergoing core needle or surgical breast biopsy at three hospitals completed a set of nine standardized, self-report questionnaires. Distress was operationalized as anxiety and/or depressive symptoms, measured by scores on the HADS and STAI State. Varying levels of distress, manifested as symptoms of anxiety and/or depression were present with 14% of the women having symptoms above the cut-off point for clinical anxiety and 13% having symptoms of clinical depression. A clear profile emerged of factors that influenced distress and of the women who were more likely to have clinically elevated symptoms. Younger women reported more anxiety (r= -.232, p = .008) on the HADS-A. In multiple regression analyses, trait anxiety explained 71% of the variance on the STAI State (R2=.842, F (1,124) =306.9, p<.001) and 44% of the variance on the HADS-D score (R2=0.738, p < 0.001). A model with trait anxiety, satisfaction with medical care, meaning in life, and friend support accounted for 66% of the variance in the HADS-D score (R2=0.814, F (4, 123) = 60.4, p < 0.001). Responses indicated that when faced with a potential cancer diagnosis, distress levels were based upon a woman's personality and her evaluation of whether she felt she had the resources to able to adapt to life with cancer. Screening protocols need to be routinely included in diagnostic radiology appointments to assess distress levels. For women with high levels of distress, interventions to decrease distress need to be tested to determine the effectiveness of providing information, facilitating communication with health care providers, and offering emotional support.