Designing and Validating a Community-Based Palliative Psychological Service Package and Evaluating Its Effectiveness on Pain Perception and Death Anxiety in Patients with Breast Cancer
Keywords:
Pain Perception, Death anxiety, Breast cancerAbstract
Objective: This study aimed to design, validate, and evaluate the effectiveness of a community-based palliative psychological service package on pain perception and death anxiety in patients with breast cancer.
Methods and Materials: In the qualitative phase, data were collected through in-depth interviews with 12 women diagnosed with breast cancer and content analysis of 22 related scientific articles. The designed intervention package was then presented to 15 psychology experts, and its validity was confirmed using survey methods and content analysis. In the quantitative phase, the statistical population included women with breast cancer residing in Khorramabad city, who were purposively selected and then randomly assigned to experimental and control groups (15 participants in each group). The research instruments included the McGill Pain Questionnaire (Melzack, 1975) and the Templer Death Anxiety Scale (Templer, 1970), both of which demonstrated appropriate reliability and validity. Data analysis, conducted using SPSS version 26 with repeated measures ANOVA and Bonferroni post-hoc tests.
Findings: The findings indicated that the intervention package significantly reduced pain perception and death anxiety in the experimental group. The package, which emphasized mindfulness techniques and emotion management training, effectively contributed to the psychological and social empowerment of the patients.
Conclusion: This study highlights the importance of integrating psychological interventions with breast cancer treatments and developing effective community-level palliative care programs.
Downloads
References
Abdelhadi, O. (2023). The impact of psychological distress on quality of care and access to mental health services in cancer survivors. Frontiers in Health Services, 3. https://doi.org/10.3389/frhs.2023.1111677
Ardeshirpey, J., Bakhshayesh, A., & Dehghan, M. (2023). Prediction of treatment adherence based on psychological hardiness, tolerance of ambiguity, and perceived social support in patients with lung cancer. Toloo-e Behdasht, 22(2), 59-73. https://doi.org/10.18502/tbj.v22i2.13265
Arefian, M., Asgari-Mobarake, K., Fazilatpour, M., Zanguri, V., & Akrami, M. (2023). Proposing and evaluating a model of depression, stress, resilience and spirituality in relation to pain in women with breast cancer: Investigating the mediating role of mindfulness. European Journal of Oncology Nursing, 62, 102268. https://doi.org/10.1016/j.ejon.2023.102268
Asghari Ebrahimabad, M., Karbalaei, H., Mazloumzadeh, M., Salaiani, F., & Maghsoudi, S. (2022). Structural equation modeling of predicting death anxiety based on COVID-19 anxiety with the mediating role of emotion regulation and meaning in life. Journal of Mazandaran University of Medical Sciences, 213(213), 92-102.
Ashtiani, M. C., Fattahi, N., Balali, D., Alavi, S. H., & Mahmoudzadeh, M. (2024). Effectiveness of schema therapy based on mindfulness on mental pain and experiential avoidance in patients with cardiovascular diseases. Journal of Assessment and Research in Applied Counseling (JARAC), 6(1).
Babanajad Derikandeh, S., Norouzi, A., & Bagheri, H. (2023). The effect of meaning therapy based on Rumi's ideas on death anxiety and depression in women with breast cancer. Community Health, 17(1), 76-86.
Battista, V., & Sciacca, K. (2023). Professional standards and the role of the advanced practice registered nurse in hospice and palliative care. Journal of Hospice and Palliative Nursing, 25(5), 249-254. https://doi.org/10.1097/NJH.0000000000000968
Braš, M., Đorđević, V., & Kaštelan, S. (2023). Palliative medicine: past - present - future. Revija Za Socijalnu Politiku, 29(3), 413-426. https://doi.org/10.3935/rsp.v29i3.1942
Carreiro, J. P., Cardoso, S., Teques, P., Teques, A. P., & Ribeiro, J. L. P. (2025). Satisfaction With Social Support and Quality of Life Among Portuguese Patients With Breast Cancer: Mediating Effects of Coping Styles—Cross-Sectional Study. Healthcare, 13(3), 297. https://doi.org/10.3390/healthcare13030297
Choi, S., Kim, S., Shin, S., Ryu, J., Baik, J., Kim, J., & Kim, N. (2018). Evaluation of outcomes of the Busan community-based palliative care project in Korea. Asian Nursing Research, 12(4), 286-292. https://doi.org/10.1016/j.anr.2018.11.001
Coutts-Bain, D., Sharpe, L., & Russell, H. (2023). Death anxiety predicts fear of cancer recurrence and progression in ovarian cancer patients over and above other cognitive factors. Journal of Behavioral Medicine, 46(6), 1023-1031. https://doi.org/10.1007/s10865-023-00422-w
Dams, L., Gucht, E., Haenen, V., Devoogdt, N., Smeets, A., Bernar, K., & Groef, A. (2023). Effectiveness of pain neuroscience education on somatosensory functioning after surgery for breast cancer: a double‐blinded randomized controlled trial. The Anatomical Record, 307(2), 248-272. https://doi.org/10.1002/ar.25127
Doan, L. (2023). Pain associated with breast cancer: etiologies and therapies. Frontiers in Pain Research, 4. https://doi.org/10.3389/fpain.2023.1182488
Drusko, A., Baumeister, D., Christensen, M., Kold, S., Fisher, V., Treede, R., & Tesarz, J. (2023). A novel computational approach to pain perception modelling within a Bayesian framework using quantitative sensory testing. Scientific Reports, 13(1). https://doi.org/10.1038/s41598-023-29758-8
Frey, R., & Balmer, D. (2023). The challenges for health professionals delivering palliative care in the community during the COVID-19 pandemic: an integrative review. Palliative & Supportive Care, 1-13. https://doi.org/10.1017/S1478951523000275
Ghafoor, D. D. (2023). Correlation between oxidative stress markers and cytokines in different stages of breast cancer. Cytokine, 161, 156082. https://doi.org/10.1016/j.cyto.2022.156082
Ghobadi, A. (2024). The effect of virtual reality on reducing patients' anxiety and pain during dental implant surgery. BMC Oral Health, 24(1). https://doi.org/10.1186/s12903-024-03904-8
HassanKhani, H., Dehghan-Nejad, J., Rahmani, A., Ghafourifard, M., & Valizadeh, F. (2022). Enhancing home-based palliative care programs for cancer patients: An action research study. Hayat, 28(4), 388-404.
Hill, W., Lim, E., Weeden, C., Lee, C., Augustine, M., Chen, K., & Swanton, C. (2023). Lung adenocarcinoma promotion by air pollutants. Nature, 616(7955), 159-167.
Hosseinpour Mohammadabadi, R., & Khoshakhlagh, H. (2023). Effectiveness of mindfulness-based cognitive therapy on sense of coherence, emotional processing, death anxiety, and body image of breast cancer patients. Sadra Medical Sciences Journal, 12(1), 12-24.
Karimi Mohajeri, Z., Karbalaee Harfteh, F., Khalatbari, J., & Fardin, M. (2025). The effectiveness of integrating schema therapy and acceptance and commitment therapy on subjective well-being and body image concerns in women with breast cancer. Journal of Psychological Sciences, 24(145), 197-220. https://psychologicalscience.ir/browse.php?a_id=2564&sid=1&slc_lang=en
Kiarashi, Z., Emadian, S. A., & Fakhri, M. K. (2023). The effectiveness of meaning therapy on fear of recurrence and death anxiety in women with breast cancer. Cancer Care Journal, 2(1), 3-10.
Liongson, F., Bhalodi, R., McCarthy, C., Menghani, S., & Siddiqui, A. (2023). Outpatient management of chronic pain. https://www.intechopen.com/chapters/85188
Lu, C., Shi, W., Hu, W., Zhao, Y., Zhao, X., Dong, F., & Liu, C. (2022). Endoplasmic reticulum stress promotes breast cancer cells to release exosomes circ_0001142 and induces M2 polarization of macrophages to regulate tumor progression. Pharmacological Research, 177, 106098. https://doi.org/10.1016/j.phrs.2022.106098
Ma, F. (2024). The relationship between psychological distress and the nursing humanistic care demands in postoperative cancer inpatients: a cross-sectional study. BMC Nursing, 23(1). https://link.springer.com/article/10.1186/s12912-024-01704-7
Mercante, A. (2024). Virtual reality intervention as support to paediatric palliative care providers: a pilot study. Acta Paediatrica, 113(4), 833-834. https://doi.org/10.1111/apa.17099
Murakami, N., Tanabe, K., Morita, T., Fujikawa, Y., Koseki, S., Kajiura, S., & Hayashi, R. (2018). Impact of a six-year project to enhance the awareness of community-based palliative care on the place of death. Journal of Palliative Medicine, 21(10), 1494-1498. https://doi.org/10.1089/jpm.2017.0696
Mzurikwao, D. (2024). Profiling of breast cancer prevalence and its diagnosis using varied imaging techniques in Tanzania. [Journal Title Not Provided]. https://doi.org/10.21203/rs.3.rs-3873411/v1
O'Malley, K., Blakley, L., Ramos, K., Torrence, N., & Sager, Z. (2020). Mental healthcare and palliative care: barriers. BMJ Supportive & Palliative Care, 11(2), 138-144. https://doi.org/10.1136/bmjspcare-2019-001986
Penberthy, J. K., Stewart, A. L., Centeno, C. F., & Penberthy, D. R. (2023). Psychological Aspects of Breast Cancer. Psychiatric Clinics. https://doi.org/10.1016/j.psc.2023.04.010
Russo, P. (2023). The importance of being early. Annals of Advanced Biomedical Sciences, 6(1). https://medwinpublisher.org/index.php/AABSc/article/view/1988
Taheri, A., Parvizifard, A., Reisi, S., Jafari, M., Mohammadian, Y., Heshmati, K., & Ghasemi, M. (2023). Associations between the perception of dental pain and pain anxiety, mental pain, and dental anxiety in Iranian sample. The International Journal of Psychiatry in Medicine, 59(1), 34-49. https://doi.org/10.1177/00912174231180855
Talayeri, A., & Bavi, S. (2023). Comparing the effectiveness of mindfulness-based stress reduction therapy and emotional schema therapy on perceived stress and distress tolerance in women with psoriasis undergoing drug therapy in Ahvaz. Journal of Psychiatric Nursing, 11(5), 40-52.
Temnaei-Far, M., & Soleimanian, Z. (2024). The mediating role of resilience and self-efficacy in the relationship between perceived social support and psychological distress in patients with breast cancer. Feyz Journal of Kashan University of Medical Sciences, 28(1), 76-85.
Vitale, M., Gallo, S., Pascadopoli, M., Alcozer, R., Ciuffreda, C., & Scribante, A. (2023). Local anesthesia with sleeperone s4 computerized device vs traditional syringe and perceived pain in pediatric patients: a randomized clinical trial. Journal of Clinical Pediatric Dentistry. https://iris.unipv.it/handle/11571/1498395
Weissman, G. (2024). Use of machine learning to optimize referral for early palliative care: are prognostic predictions enough? Journal of Clinical Oncology, 42(14), 1603-1606. https://doi.org/10.1200/JCO.24.00024
Yang, K. (2023). Subjective well-being among chinese breast cancer patients: the unique contributions of death anxiety, self-esteem, and social support. Journal of Health Psychology, 29(3), 213-224. https://doi.org/10.1177/13591053231195391
Ye, F., Dewanjee, S., Li, Y., Jha, N. K., Chen, Z. S., Kumar, A., & Tang, H. (2023). Advancements in clinical aspects of targeted therapy and immunotherapy in breast cancer. Molecular Cancer, 22(1), 105. https://doi.org/10.1186/s12943-023-01805-y
Yuan, W., Xie, Z., Dong, P., & Yang, Y. (2023). Linking perceived social support to self-esteem and social integration among adolescents with visual impairment: a cross-lagged study. Frontiers in Psychology, 13. https://doi.org/10.3389/fpsyg.2022.1054857
Zhang, M., Gong, S. G., & Xie, R. (2024). Application of enhanced recovery after surgery in perioperative nursing care of elderly patients with hip and knee arthroplasty: A systematic review and meta-analysis. Medicine, 103(9), e37240. https://doi.org/10.1097/MD.0000000000037240
Downloads
Additional Files
Published
Submitted
Revised
Accepted
Issue
Section
License
Copyright (c) 2025 Mohamad Sharif Malmir (Author); Mohammadreza Seyrafi (Corresponding Author); Saeedeh Zomorodi (Author)

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

